The anterior cruciate ligament (or ACL) is one of two ligaments situated in the middle of the knee, and is essential for the stability of the joint. This ligament is torn commonly during a sporting activity, but may also result from a simple twisting injury to the knee.
It is recommended that the tear of an ACL is treated by reconstructing or rebuilding the ligament. Failure to stabilise the joint by reconstructing the ligament may result in early arthritis. Reconstruction of the ACL is a major surgical procedure, and the rehabilitation after the operation can take between nine and 12 months.
Following the injury, symptoms include:
- Severe pain
- Almost immediate swelling of the joint
- The patient is normally not able to continue with the sport
- Sense of instability in the joint, even gentle jogging may be difficult
A torn ACL does not heal spontaneously. To stabilise the joint, a new ligament has to be reconstructed using a graft using one of the following materials:
- Patellar tendon graft
- Hamstring graft
- Synthetic graft
- Quadriceps tendon graft
A tunnel is drilled first through the shin bone and then through the thigh bone. An appropriate sized graft is passed through the tunnels and fixed very securely in each bone, using either large screws or other appropriate fixing devices. When tendon tissue is first harvested for a graft, it loses its blood supply. As a result its strength deteriorates until a new blood supply is established in it. When the graft tissue is inserted into the knee, the healing process starts and gradually new blood vessels grow into it. New cells migrate into the tissue and begin to repair and re-model the graft.
Patient physical activity is restricted, particularly for the first six weeks. After that, the activity may be gradually increased. It is usually nine to 12 months before unrestricted activities are permitted.
Mr Prakash’s approach: I perform this surgery using the arthroscope via keyhole surgery, enabling me to make sure that any other injuries to the joint are assessed and treated. It also helps me optimise the position of the graft. I prefer to use the patellar tendon graft as it has stood the test of time. It is also the preferred graft material for professional athletes and sports persons. I have performed this routinely in soldiers who have been able to achieve the highest level of fitness to be able to be deployed to war zones. I therefore chose to use this graft in not only high performance individuals, including sportsmen, but all my patients. However, I also use the hamstring tendons as graft in low demand patients, and place the graft in anatomical position. My patients go home on the day after surgery, once pain control has been achieved.
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