‘Bone Joint and Nerve Clinic’ was started in the year 2018 by one of the Best Orthopaedic Surgeons in Patna, Dr. Neeraj kumar.

To establish the centre of excellence in Orthopaedics Dr. Neeraj kumar focused on its specialities by providing a safe & secure environment and performed the duties with utmost competency through utilising effective and innovative clinical practices with profound academic research.

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ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY

01 Oct ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY

Posted at 07:55h in Uncategorized by
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Anatomy

  • 3 cm in length
  • 1 cm In diameter
  • 2 bundles
    • Anteromedial – tight in flexion and more isometric, anteroposterior stability
    • Posterolateral – tight in extension, more horizontal and provides rotational stability, responsible for medial rotation.
  • anterolateral ligament bears load in setting of ACL tear
  • 90% type 1 collagen
  • strength – 2200N
  • male :female – 1:4

Imaging

  • Radiograph
    • Segond fracture – anterolateral capsular cortical avulsion(Paul Segond 1879)
  • MRI
    • ACL discontinuity
    • fluid along the lateral wall

Treatment

  • 1/3rd will compensate well with conservative management
  • 1/3rd avoid symptoms of instability by activity modification
  • 1.3rd require reconstruction
  • initial treatment
    • brace and physio
    • closed chain exercises
  • associated injury
    • MCL INJURY
    • Meniscal injury
    • PLC injury

Grafts

  • Bone tendon bone (BTB): high strength(2600N load to failure)
    • heals in 6 weeks
    • patient can have pain on kneeling
    • increased chances of fracture
  • quadruple strand Hamstring
    • 8 – 12 weeks healing time
    • risk of saphenous nerve injury
    • load to failure 4000N
    • similar functional outcome to BTB
  • Quadriceps
    • in revision surgeries
  • peroneous longus
  • Allograft – non irradiated Achilles or tibias anterior

Procedure

  • Hamstring graft harvesting
    • 3 to 4 cm vertical incision about 3 finger breadths below the medial joint line
    • isolate the tendon with stripper
    • prepare graft with no5 ethibond in whip stitch fashion at each ends.
    • 20cm graft minium
  • femoral tunnel placement
    • at ACL footprint
    • place guide wire
    • drill button tunnel with 4 mm reamer
    • measure length of tunnel
    • drill tunnel as per graft size and length required
  • Tibial tunnel placement
    • just lateral to medial tibial spine
    • 7 to 8 mm anterior to PCL along posterior edge of anterior horn of lateral meniscus
    • drill tibial tunnel as per graft diameter
    • measure the length of tunnel
    • cycle the knee
    • insert the graft and fix it with boiscrew or titanium solid screw
  • extra-articular tenodesis of ITB
  • ALL reconstruction

Complications

  • cyclops lesion
  • kneeling difficulty
  • instability
  • graft failure due to tunnel enlargment
  • synovitis
  • arthrofibrosis
  • osteoarthritis

Physiotherapy

  • full weight bearing mobilisation with brace and crutch
  • range of motion exercises closed chain
  • 1st week 900 and gradually increased till full range of motion
  • cycling at 6 weeks
  • running at 4months
  • twisting at 7 months
  • contact sports 9 months.
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