FEATURE AFRICA HEALTH 041
cruciate ligament (ACL) injuries across the globe. Along with the obvious ligament rupture, concomitant car tilage injury and meniscal tears occur, and we know that when these impor tant structures are affected, the long-term function of the knee joint may be compromised and progression to early osteoar thritis can be seen. We all have family members and friends who have unluckily fallen off-piste, twisted their knee in friendly football or a charity rugby match. Now more than ever, we are faced with the question, “What should I do when I tear my ACL?” Although doctors, online information, and scientific journals provide resources to help guide individuals through this important question, there is no universal agreement. The result of this translates into uncertainty on the part of the patient. Immediate surgery, delayed surgery, no surgery…it takes a doctor (literally) to navigate the confusing amount of knowledge on the subject. To be honest, I do not know how patients make choices in the age of TMI, or ‘too much information’. The goal of this article is to provide a framework to help patients evaluate if they are doing the ‘right’ thing. Contrary to what many patients are told, ACL injury is not a life-
W
or death problem. This means the injury does not need to be fixed on the day it occurs, or for that matter, within the first three weeks after injury. What does science say about it? There is convincing evidence supporting both early and delayed repair, and with modern techniques, there is high probability it will be done quite well. Is
ith increasing levels of activities in youth, especially young women, and the undying desire to continue to compete and ‘play hard’ as adults, we are seeing an increasing number of anterior
there a time when the repair should be done urgently? In the setting of a locked knee, either secondary to cartilage or meniscal injury mechanically blocking the movement of the knee, the repair should be taken care of urgently. Would you continue to drive your car around on a flat tire? The same common sense principles apply here. If the meniscus is blocking movement of the knee, walking on it for a long-time is ill advised because if the meniscus tissue becomes tattered from continued weight-bearing and attempted knee bending, the chance of successful healing is less when it is finally repaired. So, what does this mean? Using a simplistic approach, the only
reason to fix the injury urgently is if you are an elite athlete and must get back to the pitch because of lost income. If one is an everyday person, then fixing the ACL can wait in most instances unless there is something blocking movement of the knee. It is that simple and lets keep it that way.
Graft choice in acL reconstruction Another important area generating many questions is what is the best graft to use for ACL reconstruction. The simple answer is the best graft is that which your preferred doctor chooses. If one asks a doctor that has a practice involving a great percentage of ACL reconstruction, then we may have a different answer. Most doctors who devote a large percentage of their practice to ACL reconstruction will be well versed with all the different graft types. In elite athletes, or those who have a significant ‘bowlegged’ knee alignment, I tend to use more patellar tendon grafts. I prefer to use hamstring grafts in most other patients. In re-dos for failed reconstruction, all graft types previously discussed, as well as quadriceps and allograft sources, can be used successfully.
“using a simplistic approach, the only
reason to fix the injury urgently is if you are an elite athlete and must get back to the pitch because of lost income”
IMAGE 1: Double Bundle ACL reconstruction: Intra-operative imaging ensure accurate tunnel placement
IMAGE 2: Anatomic Single Bundle ACL reconstruction with patellar tendon graft: Final result.
www.lifesciencesmagazines.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84