I am Dr. Shailesh Mishra an orthopedic surgeon and specialized in shoulder surgery, sports injury and joint replacement. Today I will be talking about anterior cruciate ligament (ACL) injury. It is a very important structure of knee joint. This is knee joint which is made up of thigh bone which is femur, shin bone i.e. tibia and the patella cap. ACL is a stabilizer of knee joint while doing sports or routine activity or walking. It helps in maintaining the stability of knee joint. ACL might get injured because of various activities like sudden stoppage while running. While jumping from a height because of improper landing the ACL might get damaged. In other support activities like football, volleyball and rugby, injury can harm ACL. Immediately after injury, rest, anti-inflammatory compression is the treatment when there is swelling and pain in the knee. It is very important to immobilize the knee with the help of long knee brace. After that, you must consult an ortho who will assess the degree of the injury to the ACL and to the other structure of the ligament to the knee.
The treatment varies as per the structure and injury. If the injury is partial or there is only sprain, it can healed. Symptoms are pain, swelling, restricted movement of the knee and there can also be a locking of the knee, when meniscus gets locked and torn in the knee. There can be clicking or popping sensation in the knee. While climbing stairs there can be instability of the knee. Patient may feel imbalance when they put weight on that particular injury. Treatment depends on the extend of the knee. If injury is just the sprain then ACL can heal on its own. And patient can regain the strength by exercises. If it is completely toned, it does not heal on its own. There is the fluid inside it which doesn't allow to form. Clot formation is very important for any healing processing the body. In such cases, patient usually has to go for surgery.
Surgery is in the form of arthroscopy surgery. Surgery can be performed through 3 holes. While surgery 2 tunnels are made. One is in the upper bone and one in the lower bone. And the graph is passed from the tibia inside the joint to the upper bone. This is the new tissue which can be either taken out from the patient himself that it is called autographt and if it taken from some other body than it is called allograft. In India allograft is not available. It is also not allowed by the government. My preference for autographt is hamstring tendon. With the latest technology the recovery is much faster and it saves more bones in the revision scenario. Patient might get the same injury in the future also. We have to reconstruct the new ligament for the patient. Now patient can walk from next day onwards with the help of walker or crutch.
And after 2 weeks patient can walk on his own. The patient may have questions, when they can start driving. It actually depends on the individual's strength. Neuromascular require the coordination between foot muscles and hand muscles for driving. We ask them to drive at around 6th week. After reconstruction, the ligament is fixed to the bone with the help of screw. However, there is a constant process of new collagen formation and ligament takes a year. The ligament which we are putting is totally substituted by patient own new collagen formation and this whole procedure takes around 1 year. Ligament continues to develop more strength. It also depends upon how well the patient is doing physiotherapy and rehabilitation process. Usually, by end of 1 year, sports man can resume his activities for sports. Sports person also questions whether they can perform on the same level or not. But it is entirely upon the rehabilitation and the physiotherapy. When they have complied more than 90% of strength, we allow them for the sports activity. With the help of the tests, we can assess the strength. Can they have this kind of injury again in their life? Of course, they can have. Because they are engaging in high risk activities, if they injured for the first time, they can get injured for the next time as well. However, the treatment is possible for 2nd time also. For more information or to book an appointment with me, please contact lybrate.com.