These occur after a valgus injury, Medical Tourism in India, Medical Tourism India, India Medical Tourism, Medical Tourism, Knee Replacement in India, Knee Replacement Surgery Cost, Knee Replacement Cost, Hip Replacement Surgery, Hip Replacement Cost, Cancer Treatment in India, IVF in India, Stent in Heart, Bariatric Surgery, Breast Surgery commonly during snow skiing. There is pain and tenderness localised to the site of injury, usually the midsubstance or proximal insertion and valgus instability may be elicited. Grade I injuries may be treated symptomatically; grade Il—Ill should
be braced with knee motion restricted from 10degree to 90degree for 3—4 weeks. Athletes should be warned of ‘tweaking’ pains that persist for up to a year following MCL injury. ACL and ACL-MCL injury
The history of a noncontact injury when the athlete was run-ning and tried to change direction, felt the knee ‘jump’, heard a pop and developed immediate swelling is almost diagnostic of ACL injury. If the knee took 2—3 weeks to settle down and the athlete is left with a feeling of, or
experiences, instability then any lingering doubts over the diagnosis can be dispelled. Clinical confirmation comes from increased anterior tibial translation with the knee held in 300 of flexion (positive Lachmann test) and abnormal anterior subluxation of the lateral tibial plateau (positive
Pivot shift test). The main indication for surgery is the recurrent episodes of instability that patients experience when changing direction or
landing from a jump. ACL rupture is commonly associated with injury to other structures in the knee. Meniscal tears are present 80 per cent of the time and unstable meniscal tears should be repaired at the time of ACL reconstruction. ‘Bone bruises’ visible on MRI scans represent subchondral oedema and are evidence of impact damage sustained at the time of injury.
All patients with ACL injury should undergo an intensive rehabilitation programme, with special emphasis on hamstring proprioception. The
decision making concerning the need for, and technique of, surgical reconstruction is not straight-forward. There is a massive body of literature,
but very little science. At present, the major determining factors are the degree of knee laxity and the level of sport to which the athlete wishes
to return. The decision is relatively easy at each end of the spectrum; the high-demand athlete with a loose knee probably (but stillby no means
certainly) requires reconstruction, whereas the nonsporting office worker with a fairly stable knee does not need a reconstruction. With patients
in the middle ground, who may or may not wish to adapt their sporting lifestyle to accommodate their knee, it is reasonable to adopt a
wait-and-see policy, and if functional instability develops then reconstruction can be offered at a later date.
Surgery should be delayed until the swelling and range of motion have improved in order to avoid a painful stiff knee postoperatively
(arthrofibrosis). Combination ACL—MCL injuries should be braced for 3—6 weeks to allow the MCL to heal and then have the ACL