Arthroscopic ACL reconstruction


What is ACL?

The Anterior Cruciate Ligament is the ligament that keeps the knee stable. ACL is one of the four main ligaments in the knee that connects the femur to the tibia. The knee is normally a hinged joint that is held together by the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL) and posterior cruciate (PCL) ligaments.

How ACL gets injured?

ACL injury is generally caused during the sports are when a person is hit to another person or a strong object on the knee. The injury can occur when the foot is firmly planted on the ground and a sudden force hits your knee while your leg is straight or slightly bent.
Anterior Cruciate Ligament damage is a very common injury, especially among athletes. ACL injuries can be categorized into groups- contact and non-contact based on the nature of the injury Contact injuries occur when a person or object come into contact with the knee causing the ligament to tear. However, non-contact tears typically occur during the following movements: decelerating, cutting, or landing from a jump. ACL injury is 4-6 times higher in females than in males.

Why is ACL surgery necessary?

ACL tears are not generally repaired and sewed back together, because repaired ACLs have generally been shown to fail over time. Therefore, the torn ACL is generally replaced by a substitute graft made of tendon.

• Patellar tendon autograft
• Hamstring tendon autograft
• Quadriceps tendon autograft
• Allograft patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon

What problems you may face if your ACL gets torn?

The patient suffering from ACL injury often have difficulty in walking. It can also cause loud poping sound of knees as the ligaments tear,including knee swelling and pain.

How ACL Surgery is done?

Arthroscopic ACL Reconstruction is done via key-hole surgery, wherein the torn ACL is reconstructed using a graft. This graft is extracted from your own body. Hamstring Tendon graft is the most common graft used. These tendons are dispensable and cause no long term side effects.

Small tunnels are drilled in bone to place the graft in the anatomical site of ACL.

How is post-op recovery after ACL surgery?

Some physical therapy under the guidance of physiotherapist guidance will help to regain the flexibility of the ligament, it will prevent the breaking of the tissue and will help in strengthening the muscle tone.
Approximately 4-6 weeks is required for the bone to attach to the graft. However, patient can start their normal activities like walking on their own and do some exercises under proper observation and care.

Famous Sportsman who have underwent ACL Surgery?

1. Cheteshwar Pujara (Indian cricketer and was a part of Kolkata Night Riders in 2009)
2. Luis Suarez (Liverpool Football Player)
3. Tom Brady (five-time Super Bowl champion)
4. Kieron Pollard (Cricketer from the West Indies and IPL player for Mumbai Indians)
5. Tiger Woods (World-famous pro-golfer )
6. Kurt Zouma (Football star player for Chelsea)
7. Mary Pierce (Tennis Champion)
8. Derrick Rose (Former NBA player)
9. Usman Khawaja (Australian batsman)
10. Xavier Hernandez (famous Spanish footballer who holds Barcelona’s record)

A knee joint replacement can be the fulcrum of an active, second-innings in any patient’s life. Knee replacement surgeries re-instill the freedom of physical movement, allowing one to resume living a pain free lifestyle. To have maximum benefit of a knee replacement surgery, post-surgery recovery measures are extremely important.

Follow up consultations with the surgeon and guided rehabilitation by a physiotherapist is a given in the initial weeks after surgery. However, after 6-8 weeks of post-operative period is when most patients lack the road map to proceed further.

Who should undergo Knee Replacement Surgery?
Patients who are not responding to other alternative therapies for their knee problems should consider TKR. Common problems include:

– Pain and stiffness – Severe and chronic pain that makes it difficult to walk, climb stairs and get up    from a chair.
– Bone damage- Severe joint damage from osteoarthritis or other conditions.
– Deformity- Knee is severely swollen or leg is bowed.

THE TO-DOs & NOT-TO-DOs

Cleaning wounds: For fear of applying water onto the surgical site, patients often stay away from cleaning their wounds. However, after stitch removal and healing, the area must be washed and cleaned with a soft muslin cloth, followed by application of coconut oil. Care must be taken to not scratch the area of surgery – if itching or any skin irritation persists, a dermatologist should be consulted.

Regular Exercise: Regular exercise is a must, whether one has undergone a surgery or not. Three months after the surgery, 5 sessions every week of exercise for at least 30 minutes each, is necessary. Muscle strengthening exercises done by self-motivation prove better than anything else.
Activities like cross leg sitting: A table-chair lifestyle must be adopted. The goal of a knee replacement surgery is not about letting patients sit on the floor or sit cross-legged. Such surgeries are only meant to restore the pain-free walking ability.

Regular walk: After 6-8 weeks of surgery, it is important to increase walking pace and distance. This is the best exercise to decrease stiffness and heaviness in joints. Walking ability is purely an individual capacity, and at the end of 2 months one should be able to walk 1-1.5 km every day, which can be increased to 250 meters at the end of 3-4 months, till a 3 km every day mark is achieved.

Activity level: Post TKR, swimming, cycling, golf, badminton (doubles) is allowed. However, contact sports like football, hockey, volleyball and high energy sports like paragliding and mountaineering are not good for artificial joints.

The last to recover after joint replacement are stiffness, heaviness and high flexion activities which happen at the initiation of an activity. Some warm up before initiation of movement is desirable in such case.

Weight reduction: It is desirable to reduce weight before surgery. Decreased mobility due to knee pain can be a big deterrent, and thus requires the patient to have a strong will power and live by strict diet control. Post surgery, patient should continue the diet along with gradually increasing exercises.

Antibiotic prophylaxis: Urine infection, dental problems, skin problems are notorious for producing bacterial seedling’s in artificial joints. Needless to say, prompt and adequate treatment of any infection is a must. Any undergoing dental or urology procedures should be covered by antibiotic prophylaxis.Dr.Shailendra Patil Mulund

Yearly check-up: TKR patients must visit their surgeon yearly to keep a check on any loosening in the joint which can be appropriately dealt with on time.
Patients with diabetes or hypertension should regularly measure, monitor and control the ailment. Diabetes patients run the risk of delayed infection, even months after the surgery, and hence should control blood sugar meticulously. Patients having respiratory disorders are advised to do Spirometry orPranayaam to improve lung capacity and thus their walking ability as well.
If these conditions are addressed, joint replacement surgeries may result in long term benefits. In case of any confusion about any point, it is important to seek clarity from the surgeon.

When knee pain doesn’t respond to conservative modes of treatments like medicines, physiotherapy, etc., knee replacement surgery is the answer. There are two types of surgical options available and


knee replacement surgeries done today:

Total Knee Replacement

Ideal candidate: knee arthritis with deformity.

Partial Knee Replacement.

Ideal candidate: Arthritis WITHOUT deformity. Total knee replacement are done more commonly as many patients present to the doctor very late when knee have started deforming.

Total Knee Replacement (TKR)

TKR is now among the safest and most effective of all standard orthopaedic surgeries. During a TKR , the surface of the knee bones is shaved such that the damaged portion of the knee is removed. An artificial knee is implanted using bone cement. A surgeon uses special surgical instruments to cut away the arthritic bone accurately and then shape the healthy bone underneath to fit precisely into the implant components.Dr.Shailendra Patil Mulund

Partial Knee Replacement (PKR) 

As the name implies, only a part of the knee is replaced in order to preserve as much original healthy bone and soft tissue as possible. These patients generally have osteoarthritis in only one compartment of their knee.

The knee is one of the largest joints in the body. It provides us the flexibility to do daily activities like sitting, standing, walking, running with ease. Age related knee problems are common, however, due to changing lifestyle, younger people are also experiencing knee pains. This may be due to….

Knee injury
Nutritional deficiency
Heavy intake of sodium
Smoking or drinking
Here are some of the changes that may help to strengthen the knees:

Do A Proper Knee Exercise:  There are some exercise which are targeted on the knees especially. This exercise helps in strengthening the weak muscles around knee joints it also helps in strengthening knee bones. These exercise includes sit-ups, step-ups, lunges, squats, thigh contraction, knee bends, knee strengthening stretches, swiss ball, straight leg raises.  Doing this exercises 30-40 minutes per day will help to strengthen the knee. Stop doing the exercise if knee pain increase and consult the doctor. Get a proper guidance on the exercises which are suitable for the patient.

Massage: Massage therapy is best method known to get relief of knee pain. Rubbing warm oil (coconut oil, mustard oil, olive oil) on patient’s knees will help in improving proper blood circulation in the veins around the knees. Always massage 3-4 times a week for 10 to 15 minutes to get the better result. If the patient is suffering from extreme knee pain then consult a doctor and get help of an experienced massage therapist.

Intake of Vitamin D: Vitamin D is known to be extremely beneficial for bones and joints health. Patient suffering from knee pain can get vitamin D from the sunlight. Hence exposing their knees in morning sunlight before 11 a.m. for 15-20 minutes daily is very much useful to decrease the further risk of trauma. Also, they can get the source of vitamin D from dietary source such as fish, cod liver oil, eggs yolks, dairy products and cereals.

Calcium: Calcium is essential for bone health. Thus, to increase knee strength eat lots of leafy green vegetable, dairy products, cereals, almonds, oranges.Dr.Shailendra Patil Thane

Swimming: Swimming allows exercising of knees with low pressure on joints. It can reduce stiffness and pain from the knees and helps to strengthen the bones. Swimming for half an hour to one hour alternate days a week can help to reduce knee problem. If the pain continues and if the patient feels increase in knee problem then consult a doctor and take a proper guidance for the treatment