Anterior Cruciate Ligament(ACL)
It is a twin bundle strong fibrous structure present in the front aspect(anterior) of the knee joint linking the thigh and the leg bones(femur and tibia). The two bundles of the ACL are anteromedial(AM) and posterolateral(PL) bundle.
ACL contributes significantly to the stability of the knee joint. The ACL gets torn in abnormal twisting, cutting, pivoting, and landing actions during competitive sports or during direct injuries in road traffic accidents resulting in an unstabile knee joint.
ACL tears can be treated with arthroscopic surgery, reconstructing the ACL as it was natively(anatomically) using either the hamstring, quadriceps or patellar tendon grafts.
In complete tear double bundle ACL reconstruction(both AM & PL) is done in order to regain the native stability of the knee joint. In partial tear involving one bundle alone a selective single bundle reconstruction of the ACL, either AM bundle or PL bundle is reconstructed preserving the intact bundle.
Posterior Cruciate Ligament(PCL)
It is a twin bundle strong fibrous structure linking the thigh and the leg bones(femur and tibia) situated in the back aspect(posterior) of the knee joint contributing significantly for the stability of the joint. The two bundles of the PCL are anterolateral(AL) and posteromedial(PM) bundle.
PCL gets torn in high velocity accidents or abnormal sporting actions causing excessive forces across the knee joint resulting in an unstable knee joint. PCL tear is treated with arthroscopic surgery, reconstructing the PCL as it was natively(anatomically) using hamstring tendon grafts.
In complete tear of PCL, double bundle PCL reconstruction (both AL & PM) is done in order to regain the native stability of the knee joint. In partial tear involving one bundle alone a selective bundle reconstruction of the ACL, either AM bundle or PL bundle is reconstructed preserving the intact bundle.
The meniscus are two in each knee joint, one in the inner aspect(medial meniscus) and one in the outer aspect(lateral meniscus). The meniscus acts as a shock absorber between the thigh and the leg bones(femur & tibia) by spreading the forces acting across the knee joint over a wider area. The meniscus gets torn during abnormal twisting forces in the knee. The torn meniscus can be repaired, partially excised (meniscectomy) or transplanted (allograft) depending on the type and location of the tear.
The collateral ligaments are two in each knee joint, one in the inner aspect named medial collateral ligament (MCL) and one in the outer aspect named lateral collateral ligament (LCL).
The collateral ligaments gets torn due to excessive outward(valgus) or inward(varus) forces to the leg during sports or road traffic accidents. Collateral ligament tears result in instability of the knee joint.
The collateral ligament tears can be treated by operative repair or reconstructing. In mid substance tears the ligaments have to be reconstructed using hamstring tendons. In acute avulsion from either end (femur or tibia attachments) the ligaments can be primarily repaired using suture anchors and fibre wires.
Medial Patella Femoral Ligament(MPFL)
It is firm fibrous structure attached to the inner (medial) aspects of patella and femur bones. MPFL acts as a restraint preventing the dislocation of the patella.
Incompetent MPFL may occur due to absence since birth(congenital) or due to injury leading to recurrent dislocation of patella. MPFL is reconstructed using hamstring tendon graft.
In this procedure the minimal cartilage wear present in early osteoarthritis is debrided and supplemented with one or more of the following - chondral microfracture, cartilage repair, platelet rich plasma(PRP) therapy and lateral retinaculum release(in predominant patella femoral osteoarthritis(PFOA)). This provides significant symptomatic pain relief.
Knee joint synovial tissue inflammation is present in inflammation(rheumatoid arthritis), infection(tuberculosis) or tumor like condition(pigmented villo nodular synovitis & synovial chondramatosis). Arthroscopy surgery is performed for diagnostic(synovial biopsy) as well as therapeutic purpose(synovectomy).