A ligament is basically a restraint between two bones. Ligament limits certain types of movements and it provides stability to any joints. Our knee joint is one of the most important joints in the body and the most commonly injured joint in the body.
The knee joint has multiple ligaments; they are collateral ligaments on the side that will not allow the knee to bend 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 the posterior cruciate ligament. It will not allow the knee to slightly forward or to slip forward the same way there’s another ligament called anterior cruciate ligament or ACL. It will allow the knee to flex but it will not allow the knee to slip backward. so this is the role of the anterior cruciate ligament.
ACL injuries are common injuries these are called common under sports injuries in western countries most of the injuries are sports injuries. Football, basketball, tennis any other sports, quite common injuries during aggressive sports. But in India another mode of injury during motorbikes accidents because two-wheeler riding is very common in India, out 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 come 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 poor blood supply, when the blood supply is poor the healing capacity is very limited, most of them do not heal, even if they do the heel, probably in a lack position or long position making the ligament very ineffective. In that shell when ACL is completely turned it will unlike it heal and function well again.
What will happen if you leave it alone?
If you leave acl alone most patients are able to walk slowly not much pain or problem. Majority of patients feel what is a big problem here. I am able to walk, able to take care about my activities well but whenever they try to walk fast and turn the ligament because they are not functioning the knee tends to slip and give away and tend to fall. Initially the instability will happen once in a while but gradually the other ligament also start taking blent the instability become more and more more common. Sometimes 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 slow and conscious at your activities so that is one reason, and the second one is wherever there’s a slip that cartilage and washers which are meniscus in the knee getting gradually warn of damage, eventually over 10 to 15 years the knee develops arthritis. If he is an old person above 60 he need not run or walk fast we may advise wearing a brace belt on the knee it provides stability on the knee and you can walk a little bit slow a little bit conscious and avoid all sports. Usually, that’s our advice, In case the knee wears off 10 to 15 years we tell them like in the 70’s there is no problem in doing knee replacement, we do knee replacement and give a good solution. But let’s say somebody is 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 use for them. The 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 is that we take a ligament somewhere else from your body and then put it back in the place of the ACL to make it back.
Why do we take these ligaments?
There are many tendencies that 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 a problem in the original place where we take them. The common examples are the two muscles are called are abstract to tendency. the bone petaltendence will take part of the tender part of the tenant. There are several examples, Most commonly used is abstract tendency.
How do we reconstruct a new ligament is like arthroscopy surgery, keyhole surgery where we make two holes in the knee in one hole we put a camera we see inside your knee through the monitor another hole we put very sophisticated instruments make whatever necessary elements need to be done to and insert a new ligament.
.How do we attach a new ligament, we make tunnels in bones, one in the leg bone and one tunnel in the 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 are a standard method of performing but when we progress to starting something called bioabsorbable 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 over time. 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 a lot of loss of bone and worry lead to loss of and a lot of hollowness and in future, if maybe ligament fracture it may be difficult to repair it again and losing a lot of bone, so there 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 a 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. In this method generally, the loss of bone is less, pain is less. We use one ligament instead of two ligaments. The recovery is usually faster without much physiotherapy. This advanced method is almost done in western countries and certain centers of excellence in India also.
What happens after the surgery?
Usually, the patient is able to walk on the 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 the knee to support the ligament while it is healing and also waking aid like elbow crunch or single crunch. so the 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. Heavy manual work is to avoid for 2 to 3 months, If they want to run they probably can be jogging for about three months time but sports should be avoided up to 6 months because the new ligament to regain strength as much as possible before they get back to like sports.