What is ACL, how does it get injured, what are the consequences of ACL injuries, how does it heel, what needs to be done in ACL injuries, who needs treatment, what kinds of treatments are there and how are the surgical steps, surgical types and what happens after the surgery and how do patients recover.
A ligament is basically a restraint between two bones. In the knee joint there are multiple ligaments are there these are called collateral ligaments on the side. This is holding the two bones to a side while allowing the knee to function ,to bend it will not allow the knee to bend other way or to slide,so that is the function of Ligament.
Ligament limits certain types of movements so its provides stability to any joints.so our knee joint is one of the most important joint in the body and most commonly injured joint in body. Knee joint has multiple ligaments they are collateral ligaments on the side which will not allow the knee to bend a sideways,the same way two ligaments called cruciate ligaments,which are basically like across one is from back to front other one is front to back,the ligament from back to front is called posterior cruciate ligament.it will not allow to knee slight forward or to slip forward same way there’s another ligament called anterior cruciate ligament or ACL which is come from here to their.it will allow knee to flex but it will not allow the knee to slip backward.sothis is role of anterior cruciate ligament.
ACL injuries are common injuries these are called common under sports injuries in western countries most of the injuries are sports injury. football,basketball,tennis any other sports.quite a common injury during aggressive sports. But in india another mode of injury during motorbikes accidents because two wheeler riding are very very common in india,lot of accidents happening.most of the people when they fall get twisted,when the knee twisted the ligaments become very tight sometimes breaks.these all are under ACL injuries.
What happens in ACL injury? Does it heels or does not heel?
The ligaments inside the knee Mainly the ACL have a very very poor blood supply,when the blood supply is poor the healing capacity is very very limited,most of them do not heal,even if they do heel,probably in a lack position or long position making the ligament very ineffective.so in that shell when acl is completely turn it will unlike it will heal and function well again. what will happen if you leave it alone.if you leave acl alone most patients able to walk slowly not much pain or problem. Majority of patients feel what is big problem here person able to walk,able to take care about his activities well but whenever they try to walk fast and turn the ligament because they not functioning the knee tends to slip and give away and tend to fall.initially the in stability will happens once in awhile but gradually the other ligament also start taking blent the instability become more and more more common.some times you may fall,injure other factors of your body including fractures. You also may develop a fear that you may slip or fall,you may hesitate to walk fast.so you may become very very slow and conscious at your activities.so that is one reason.and second one is wherever there’s a slip that catalase and washers which are meniscus in the knee getting gradually warn of damage.so eventually over 10 to 15 years the knee develops a arthritis.if he is old person above 60 he need not run or walk fast we may advise wear a brace belt on the knee it provide stability on knee and you can walk little bit slow little bit conscious and avoid all sports .usually that’s our advice.incase the knee wears off 10 to 15 years we tell them like in 70’s there is no problem in doing knee replacement,we do knee replacement and give a good solution.but early 20 ,30, or 40 they would like to be active ,walk do activities without much pain and fear and freely the knee belt is not much useful for them Second one they don’t want the knee to be worn off at 20 or 30 knee replacement is not advisable at that age. So younger people when they tear their acl usual advice is they should get the ligament to be reconstructed.what it means that we take a ligament in somewhere else from your body and then put it back in the place of the ACL make it new ligament back.
Why do we take this ligaments. They are many tendence which are similar like ligaments ,many ligaments from where we take part of them and make a new acl for you and there will not be too much of problem in the original place were we take.the common examples are the two muscles are called are abstract to tendence.the bone petaltendence the will take part of tender part of tenant.there are several examples . most of commonly used is abstract tendence.how do we reconstruct new ligament is like arthroscopy surgery,keyhole surgery were we make two hole in the knee.in one hole We put a camera we see inside your knee through the monitor ,other hole we put very sophisticated instruments make whatever necessary elements needs to be done to and insert a new ligament. how do we attach new ligament, we make tunnels in biones one in the leg bone and one tunnel in thigh bone then we pass this ligament in two bones that ligament, either side of the bone for new ligament,stable ligament and reconstruction that is surgery. There are several methods to doing this surgery almost all are done arthroscopy in nowadays.even during arthroscopy the method of fixing is usually what we do is put a big tunnel in bones and fix with metallic screws usual titanium screws that is standard method of performing.but when we progress to starting something called bio absorbable screws or biocomposite screws which are made with materials that are either absorb or blent with bone so that you not left with metal in your body.this happens overtime.but nowadays another new method called all inside technique where the reason for the technique is when we make big tunnels through your bones there is lot of loss of bone and worry lead to loss of and lot of hollowness and in future if maybe ligament fracture it may be difficult to repair it again and losing lot of bone. so three is new method is all inside technique.the technique used is called reversing tunneling where we only tunnel very little of the bone by preserving lot of original bone and we pass this ligament and fix it called tightrope or loops which are very very small metal pieces so that it is very stable fixation.so in this method generally the loss of bone is lees,pain is less.we use one ligament instead of two ligaments the recovery is usually faster without much physiotherapy.so this advance method which almost done in western countries and certain centers of excellence in india also. What happens after the surgery Usually patient is able to walk in same day and usually get discharged in 1 to 2 days from the hospital and he is able to walk and able to look after himself.we do ask them to wear a belt for knee to supporting the ligament while it is healing and also waking aid like elbow crunch or single crunch.so first two weeks usually walk around the house only.but after 2 weeks if they want to go office and outside the home and do a desk job they are allowed to do so. But little cautious.but heavy manual work is to avoid for 2 to 3 months.if they want to run they probably can be jogging about three months time but sports should be avoided upto 6 months because the new ligament to regain strength as much as possible before they get back to like sports.