ACL – Anterior Cruciate Ligament, Reconstruction Surgery is Done For Injured Ligaments of the Knee

ACL is a ligament in the center of your knee that becomes damaged when twisted or injured. The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee.

ACL reconstruction is surgery to replace the torn ligament. ACL Reconstruction is performed using a combination of open surgery and arthroscopy. Patients with ACL tears who place high demands on their knees, generally require ACL reconstruction.

WHO NEEDS?

o Most people expecting to return to high-level athletic activities in sports such as soccer or basketball

o Individuals who experience recurrent episodes of knee instability due to anterior cruciate ligament deficiency

o Patients who do not want to attempt conservative therapy

PROCEDURE

ACL reconstruction is surgery to replace the torn ligament. There are several choices of tissue to use for the new ligament, including tissue from your own body (an autograft) or tissue from someone who has died (allograft). The most common autografts use part of the tendon in the front of the knee (patellar tendon) or in the hamstring. Each type of graft has small advantages and disadvantages, and works well for many people.

Knee arthroscopy is a surgical procedure in which a pencil-sized instrument called an arthroscope is inserted into a joint without any open cut or incision. Fluid is then inserted into the joint to allow the surgeon to thoroughly examine the interior of your knee and determine the source of your problem.

The surgeon checks the cartilage and ligaments of the knee. If there is other damage, such as a meniscus tear, the surgeon will fix the problem. You will most likely go to sleep for the procedure, but it can be performed under different types of anesthesia.

Then, the surgeon will replace the ACL. Other small incisions are made around the knee to place the new ligament. The old ligament will be removed using a shaver or other instruments. Bone tunnels will be made to place the new ligament in the knee at the site of the old ACL. If your own tissue is to be used for the new ligament, a larger, “open” incision will be made to take the tissue. The new ligament is then fixed to the bone using screws or other devices to hold the ligament in place.

At the end of the surgery, the incisions are closed, and a dressing is applied.

REVISION OF ACL RECONSTRUCTION

Failure of an ACL reconstruction is often hard to describe. The patient can have complaints of knee instability, pain, stiffness, or the inability to return to desired activities. Treatment for failed ACLs is complex and technically challenging, and the results of revision ACL surgery are not as good a primary ACL reconstruction. It is therefore important to follow a specific approach to evaluate, diagnose, and treat potential revision ACL cases. Causes of failure like drill hole placement in a nonanatomic location, failure of fixation, graft impingement, intrinsic graft failure, arthrofibrosis and trauma. With the help of arthroscope the patient’s knee is then evaluated within the joint and any scar tissue is removed. Precise placement is necessary for a successful revision. If the old hardware is in the way of the ideal tunnel placement it is removed usually under fluoroscopic (x-ray) control. The anatomic insertion site on the femur for the original ACL is identified, and a drill hole is initiated using a gaff to place a rear-entry guide, then drilled from outside in. The hole is cleared out and the edges are chamfered (rounded) to avoid damage to the graft.

Next, the insertion site of the ACL on the tibia, on the tibial plateau, is identified, and a drill hole is initiated using a triangle-guide, again drilling from outside in. The hole is cleared out and the edges chamfered in a similar manner.

The graft tissue, which usually is a bone-patellar-tendon-bone graft, is brought through the now continuous tunnel running from the femur through the knee joint and through the tibia. The tissue is secured in place using 9x20mm screws, which bind the bone blocks at either end into the tunnel.

The knee is finally brought through a full range of motion to visualize for any impingement of the graft, and to ensure proper placement. The instruments are removed and incision sites closed, the joint injected with Marcaine for pain relief, and the patient is able to return home later that day.

ACL provides almost 90% of the stability to the knee joint. ACL reconstruction is a highly successful operation. With good rehabilitation, 90% to 95% of individuals who undergo this surgery can expect to return to full sports participation within six months.

In India, Apollo hospitals have the required expertise to treat the above disease.



Source by Pankaj M. Nagpal

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