A torn ACL does not heal spontaneously. To stabilise the joint, a new ligament has to be reconstructed using a graft using one of the following materials:
• Quadriceps tendon graft
• Patellar tendon graft
• Hamstring graft
• Synthetic graft
The inside of the knee is visualised by an arthroscope. A tunnel is drilled first through the shin bone and then through the thigh bone. An appropriate sized graft is passed through the tunnels and fixed very securely in each bone, using either large screws or other appropriate fixing devices. When tendon tissue is first harvested for a graft, it loses its blood supply. As a result its strength deteriorates until a new blood supply is established in it. When the graft tissue is inserted into the knee, the healing process starts and gradually new blood vessels grow into it. New cells migrate into the tissue and begin to repair and re-model the graft.
Patient physical activity is restricted, particularly for the first six weeks. After that, the activity may be gradually increased. It is usually nine to 12 months before unrestricted activities are permitted.
Prof Prakash’s approach: He performs this surgery using the arthroscope via keyhole surgery, enabling him to make sure that any other injuries to the joint are assessed and treated. It also helps him to optimise the position of the graft. He prefers to use the quadriceps tendon graft as it gives a predicable sized graft. He has also used other graft materials like the hamstring and the patellar tendon. He has performed this surgery in many soldiers who have been able to achieve the highest level of fitness to be able to be deployed to war zones. He choses to use this graft in not only high-performance individuals, including sportsmen, but all his patients. He places the graft in anatomical position. His patients go home on the day after surgery, once pain control has been achieved.
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Further read: https://orthoinfo.aaos.org/en/diseases–conditions/anterior-cruciate-ligament-acl-injuries/