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ACL Tear Treatment by Keyhole surgery(Arthroscopy)

Hamstring ACL reconstruction, Arthroscopic ACL reconstruction, Sports Injury Treatment, Knee Ligament injury, ACL ligament repair

Posted by Dr Jayant Arora on February 11, 2012 at 8:35 PM 20344 Views

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18 Comments

Reply hospitalkhoj
2:19 AM on July 5, 2014 
Top Private Hospitals in Kolkata would be compensated in occupied because of tariff agreements they have with the Hospital groups. To have the Surgeon and Anesthetists bill fully roofed, the member would have to use a practitioner who is slender to charge the DHR (Discovery Health Rate) or buy an opening product.
Reply a k upadhyay
9:31 AM on January 21, 2014 
thanks dr arora.read your e mail regarding acl injury.my accident occure on 16 dec 2013 i am moving with a knee brace no physiotherapy stated till now.may i start phesiotherapy.medicin taken only 7 days.latest MRI report is as follows.subtotalACLtear about 70% seen in superior substance. marrow edema seen in lateral femoral condyle.mild joint effusion present.mild soft tissue injury seen around knee joint. tibial codyle,pattela,proximai fibyla,joint space, compartments appears normal.B/Lcolateral ligaments normal medial& lateral menisci normal. PCL appears normal in orientation morphologu&sl allignment of femur&tibia at joint are normal.visyalized articular cartilages appears normal.as compared to previous MRI dt 21/12/2013 edema at tibial condyle is redused no any other radiological change is seen.
Reply Dr Jayant Arora
11:55 AM on June 4, 2013 
Dear Chaitanya
The fact that you have had numerous episodes of buckling and giving way in the knee, it appears that you have significant residual instability in the joint despite exercises. In view of your MRI findings of a complete ACL tear, the situation can be usually improved by reconstruction of the torn ACL ligament using arthroscopic surgery. Following the surgery instability is resolved and strenuous sporting activities can be resumed.

It is imperative that you see an Orthopedic surgeon with specialization in treating the knee ligament injuries, who would examine your knee and review your MRI scan images before deciding on the surgical procedure.
Thanks
Reply chaitanya mevawala
5:10 PM on June 3, 2013 
Dear sir,
i had an knee injury before 4 months while playin cricket.
so Doctor sugeested me 4 MRI and the reports were as under:-

1) Complete anterior cruciate ligament tear at its mid subatance.
2) Grade 1 horizontal tear in posterior horn of medical meniscus.
3) moderate joint effusion in knee and tibio-fibular joint.
Sir,
as doctor suggested my leg was stabilised for a month and i was doing the leg exercise as i was suggested after d stabilization,but the problem is i used to fall when i have a sudden change in direction of motion and happened many a times.
But i am not having any pain in daily lifestyle...
i am not able to get whether the healin is done or not and would i be required an surgery even after this..
i would be very greatful to you if you can give your sugeestions to me..
thank you,
chaitanya mevawala
Reply Dr Jayant Arora
5:24 AM on April 14, 2013 
Dear Amit

Your situation is same as many of my patients who have taken treatment from me. They fail to recognise that ACL tear is a very significant knee injury and if left untreated, will result in early arthritis in the knee joint. Very often, I have reconstructed torn ligaments 5-6 years after the injury. Patients are either not diagnosed or are treated in a plaster for these injuries and they suffer for years leading to worsening of the problem.
Torn ligament can be treated with a keyhole surgery and patients resume normal lifestyle including extensive sports after recovery, but arthritis resulting from missed or neglected ligament injury cannot be treated and often results in major surgery like a knee replacement later in life.

You have to recognize that pain in your knee is due to the ongoing damage that is happening even on routine activities due to ligament injury and will result in arthritis a few years down the line, if it remains untreated.
It is very likely that now you may have worsened the meniscus injury from a grade 2 to a grade 3 tear or even a bucket handle tear which is causing locking of the knee joint. This can be confirmed with a repeat MRI scan/clinical examination and can be treated simultaneously with the ligament reconstruction.

Unless I examine you, it is difficult for me to give you a specific treatment guidance, but I suspect that you will need arthroscopic surgery to improve your knee condition.
Reply amit sharma
12:51 PM on April 12, 2013 
Dear sir,
i am 31 year old. I had a fall from bike accident in 2008, escaped any external injuries but my right leg-knee couldn't take any load. MRI report-
MR imaging reveals joint effusion with:
- Complete ACL tear
- Horn in lateral meniscus
- Grade-II
after accident i have problem at the time suddenly moving it is like a locked & free after bones braking sound ,pain & instability.
i didn't goto hospital as i am employee having busy schedule .
but i also play cricket . please advise me what i do because now i have much pain in my knee after one stroke.but now instability is not notice in my knee.
i am waiting for your reply.
Thanks & Regards
Amit Sharma
Reply Dr Jayant Arora
12:59 PM on March 10, 2013 
Dear Sourav
Ultrasonography is not a very sensitive test for ligament and meniscus injuries. Persistent knee swelling, even after 1 month of injury is not normal and indicates that the injury was missed on the scan. I would like to examine your knee to come to a diagnosis before advising any treatment. Furtther investigations like an MRI scan may also be nedeed.
Reply sourav singha roy
4:55 AM on March 10, 2013 
sir m 21 yrs old.m got injury while playing football on 28.1.2013.i have done ultrasnography..report is-irregularity in medial meniscus.lataral meniscus and acl and pcl is normal.no ovious tera seen..still now sweelling is noticed.m aslo applied r.i.c.e formula.sir plz tell me what i do.??
Reply Dr Jayant Arora
8:54 AM on February 24, 2013 
Dear Akul
I need to examine your knee before deciding if you need any surgery. However in general no surgery is required if you do not have any instability in the knee, it doesn't lock or buckle while playing and you do not have any problems in sports involving sudden change in direction while running like football, tennis etc.
Reply Akul sharma
12:11 AM on February 24, 2013 
sir im 22years old boy ,, and im having a ligament tear in my right knee on 16/3/2012,after which i undergone MRI and following results come i.e ACL tear Grade-1, Lat-Meniscal tear, joint effusion, for which i do physiotherapy IFT, Ultrasonic therapy,nd hotpack. for 1month. then after again having 2nd MRI ,the results are Partial ACL tear Grade-2 and joint effusion,, MCL and LCL are normal . after that i didn't goto hospital as im student having busy schedule but my knee condition is good, full motion of knee, bending is good and i started running also jogging type. but i get tired there's little pain in my knee and muscle. do i have to go for surgery.
Reply Dr Jayant Arora
11:52 AM on February 21, 2013 
Dear Mr Krishna Kumar.
You should wait for atleast 4-6 weeks before undergoing ACL reconstruction and Meniscus tear treatment. Surgery would most likely be needed since you have sustained significant damage to the knee structures.
At present you could follow the instructions mentioned in the following link--
http://www.gurgaonkneeandshoulderclinic.com/aclinjury.htm
Reply V Krishna Kumar
8:36 AM on February 21, 2013 
I'm 44 year old and a ex-sportsman. On 18.02.2013, I had a fall from scooter-skidding accident, escaped any external injuries but my right leg-knee couldn't take any load. MRI report-
MR imaging reveals joint effusion with:
- Complete ACL tear
- Horizontal and vertical tear posterior horn and body of lateral meniscus
- Grade-II sprain in medial and lateral collateral ligaments
-Bone contusion in patella, tibia and Femur

Presently undergoing full bed rest with braces on. Kindly suggest what immediate measures are to be taken, if operation required, minmum period of rest before undergoing operation and approx budget required for the same.
Reply Dr Jayant Arora
12:34 PM on February 7, 2013 
Dear Vishal
You don't have to undergo surgery if you do not have instability in the knee on routine activities. Exercising the thigh muscles will help to minimise instability in the knee after these injuries. You could find these exercises on ACL injury section. But then, you will not be able to participate in any sports or recreational activities like dancing etc as your injured knee may becone painful and unstable. I would like to examine your knee, if possible, to ascertain the laxity in the joint.

If your Knee "gives way" or "shifts" of routine non strenous activities then surgery is recommended to make the knee stable as recurrent episodes of slipping/giving way will lead to damage to normal uninjured structures like meniscus etc resulting in early arthritis.

Surgery is reasonably straight forward and can even be carried out as a day care procedure using arthroscopic techniques(Keyhole surgey).Ocassionaly,patients choose to stay in for a night in the hospital , primarily for insurance realted reasons.

Following the surgery and adequate rehabilitation, you could resume normal life are before including sports and other recreational activities.
Reply vishal jain
6:22 AM on February 7, 2013 
Sir, I am a 34 yr old male , I got injured while playing football,
Doi: 10/01/2013
Moi: injured in lt knee, while playing foot ball,
I don?t want to go for operation, so please suggest me something other than surgery.
Vishal jain MRI Report of left knee.
MRI. Features.
There is complete thickness tear in the proximal fibers of the ACL near its femoral attachment.
Multiple areas of altered marrow singnals hyperintense on T2 and STIR sequences, hypointense on T1
Are seen in the both lateral femoral condyle, tibial spine and lateral tibial plateau and represent bony contusions.
Mild joint effusion is also seen.
Grade 2 strain in the lcl also seen.
Partial thickness tear in the lateral patellar retinaculum noted.
The antirior and posterior horns of both menisci appear normal in signal and morphology.
The pcl appear normal.
The mcl appear normal.
The patella appear normal.
Articular cartilage appears intact.
The soft tissue structures around the knee shows edematous changes.
Reply Dr Jayant Arora
2:48 PM on February 5, 2013 
You have classical sports injury, where a torn ACL is also associated with a torn meniscus.



In my opinion, surgery is the recommeneded treatment if you feel that your knee is unstable and wobbly. I can understand your reluctance to undergo the surgery, but I do not think that there is an effective alternative treatment for these injuries. I have treated numerous patients with similar injuries 4-8 years after the time of accident. These patients had tried many different treatments but would eventually came for surgery as their knee remained painful and unstable.

Delaying the knee surgery in your situation will only result in aggrevating the injuries further and will lead to early arthritis in a few years time.



After surgery, you will be able to walk from next day with your knee protected in a brace. This procedure can be done a s a day case but ocasionally 1 day hospital stay may be required.

There are usually no stitches after this surgery as the procedure is done through a key hole technique.



Driving has to be avoided for 2 month post surgery and sports have to be avoided for 6 months
Reply ketan bansal
2:42 AM on February 5, 2013 
Sir, I am a 20 yr old male , I got injured while playing basketball,
Doi: 29/07/2012
Moi: injured in lt knee, while playing basket ball,
I don?t want to go for operation, so please suggest me something other than surgery.
My MRI reports says:
FINDINGS:
1. There is loss of continuity of the ACL with intrasubstance hyperintensities especially at its tibial end, however both the attachements are maintained. There is associated PCL buckling of 95 degrees and an anterior tibial translation of 8mm.
2. There is grade 3 tear of posterior horn of the lateral meniscus.
3. The femoral and tibial condyles, patella and fibular head appear normal in outlines and marrow signal.
4. The medial meniscus appears normal in outlines and signal characteristics.
5. The posterior cruciate ligaments, medial and fibular collateral ligaments , quadriceps tendon and ligamentum patellae appear normal in outlines and signal characteristics.
6. There mild synovial effusion seen.
IMPRESSION:
1. Grade 2 ACL tear.
2. Grade 3 tear of posterior horn of lateral meniscus.
Reply Dr Jayant Arora
9:32 AM on February 4, 2013 
Dear Ketan
If you have instability in the knee along with pain/discomfort that is persistant even after physiotherapy, surgery(reconstruction of the torn ACL with partial resection of the meniscus) can be considered. Associated meniscus damage is very common along with ACL injuries and usually result either at the time of orignal injury or as a result of the instability in the knee.
Reply ketan bansal
6:02 AM on February 4, 2013 
.grade 2 acl tear
.grade 3 tear of posterior horn of lateral meniscus
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