Department Of Arthroscopic Surgery and Orthopaedics Sports Medicine
Sports Medicine is a relatively new and rapidly evolving super specialty in India. The sports medicine specialist includes orthopaedic surgeon with training in arthroscopic surgery, physician, physical therapist and athletic trainer. The orthopaedic surgeon has to deal with operative and non-operative issues involving athletes. Arthroscopic surgery has a major role to play in the treatment of injured athletes. The advantages of this minimally invasive technique are:
1. Early return to sport 2. Precise repair / reconstruction of joints 3. None or minimal blood loss doctor 4. No external stitches 5. Day care procedure 6. Reasonable cost
Arthroscopic surgery is done for all the major joints of the body. The knee joint injury is quite often seen in injured sportsman. Approximately 50% these injuries may be cruciate ligament tear. The anterior cruciate ligament is more often injured than posterior cruciate ligament. We are going to discuss the anterior cruciate ligament (ACL) injury in this article.
ACL is a 33 mm long band of fibrous tissue that connects the femur (thigh bone) to the tibia (shin bone). Its function is to control and limit the amount of forward movement of the outer side of the knee joint while performing twisting actions. The cruciate ligament is usually not required for normal daily living activities; however, it is essential in controlling the rotational forces developed during side stepping, pivoting & landing from a jump.
The ACL is commonly injured whilst playing the running ball sports or skiing. Whilst playing the ball sport, momentum is developed and upon attempting a pivot, side step or propping manoeuvre, the knee gives way. When skiing rupture may occur at low or high speeds. Commonly the binding fails to release as the ski twists the leg resulting in tearing sensation. Patient frequently hear or feel snap or crack accompanied by pain. Swelling commonly occurs within the hour but can be minimised by application of ice or compression. Frequently pain is felt on the outer aspect of the knee as the joint dislocates. This dislocation may be felt to reduce with a clunk.
The initial treatment of any knee ligament injury shluld consists of ice packs, compression bandages and crutches. It is difficult to weight bear for several days. However, after seven to ten days the swelling settles and walking is possible with the joint gradually regaining a full range of motion. By four weeks following injury the knee becomes almost normal. Patients who return to sport usually notice a weakness or instability. Further episodes of instability result in multiple injuries to the joint surfaces and menisci (shock absorbers). The damage to these structures eventually leads to osteoarthritis at young age.
The goal to treatment of an injured knee is to return the patient to their desired level of activity without risk of further injury to the joint. For those patients, who wish to pursue ball sports or who are involved in an occupation that demands a stable knee, surgical reconstruction is recommended.
We perform arthroscopic ACL reconstruction using hamstring tendons as a graft. Arthroscopy is performed through antero-medial & antero-lateral portal. Through a small incision hamstring tendons are harvested. Small tunnels are drilled in the bone for the graft. The graft is inserted into the drilled tunnels and fixed in place with screws. At present, this technique of ACL reconstruction is done only at our centre in India.
Physiotherapy is commenced preoperatively and continued post operatively. Most patients start walking normally 14 days following surgery. By the end of six weeks jogging under controlled conditions is recommended. Playing non-competitive sport is possible by six months. A return to competitive sport is permitted at 9 – 12 months following surgery.
This technique has a very high success rate. The graft failure due to poorly understood biological reasons occurs in approximately 1 % of patients.