Sunil Shivanna

Abstract

Multiligamentous knee injuries (MLKI) are rare orthopedic injuries with involvement of two or more ligaments in the knee. There are variety of combinations of MLKI and one such relatively common and important injury pattern is anterior cruciate ligament (ACL) plus medial collateral ligament (MCL) injury. Though MCL grade 1 and 2 does not warrant surgical management, grade 3 defintely needs reconstruction or repair according to past studies so as to avoid valgus instability. A retrospective study was conducted evaluating the outcomes of combined ACL and MCL injuries in 22 patients at our centre. Road traffic accidents (RTA) accounted for 45.5% of the total cases as the most common mechanism of injury. Out of 22 patients operated with simultaneous ACL and MCL reconstruction, 14 (63.6%) had good results based on Lyscholm scoring system, 5 (22.8%) had excellent results, and 3(13.6%) had fair result and none of our patients had poor results. Simultaneous single stage management of ACL and MCL injury has advantages like early rehabilitation, reduced number of hospital stay as well as absence of necessity for getting admitted and operated for each ligament separately which also brings down the cost to the patient. Keywords: Reconstruction, ACL, MCL, Lyscholm.

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Abstract

Introduction: Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injury is relatively a rare entity and it is extremely important to manage these injuries with great accuracy, as this may involve damage to neurovascular structures associated with knee dislocation and also carries the risk of accelerated joint degeneration if left untreated. There are many issues that are topic of debate even today like timing of surgery, graft of choice and single stage versus staged reconstruction. Materials and Methods: A prospective study for evaluating the outcomes of combined ACL and PCL injuries in 20 patients was conducted at our centre, who were managed arthroscopically. Preoperative and post-operative Lyscholm scores and IKDC scores were assessed to evaluate the patients outcomes. Results: Out of 20 patients operated for ACL and PCL injury, 14(70%) of them had excellent to good results and the rest 6(30%) had fair results with none of the patients reporting poor results. Conclusion: Simultaneous ACL and PCL reconstruction using arthroscopic technique is an effective and safe procedure irrespective of the time since injury and also this is more helpful to achieve early rehabilitation. Keywords: PCL, Lyscholm score, IKDC.

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Abstract

Introduction: Injuries to the acromioclavicular (AC) joint represent a wide variety of soft tissue disruptions that result in mild pain to significant displacement, chronic pain & changes in shoulder biomechanics resulting in long term morbidity. Main aim is to study the outcome of AC joint dislocation managed by tension band wiring, which is cost effective & also gives excellent results in cases of traumatic AC joint dislocation. Methods: 23 cases of type 2 & 3 AC joint dislocation were selected depending on Rockwood classification for a period of 12 months (January 2019 – December 2019), who all underwent Tension band wiring (TBW) & followed the post-operative protocol accordingly with minimal mobilization to full range of movement, with suture removal on day 12 followed by maximum possible range of movement by 12 weeks onwards. Results: We had majority type 3 AC joint dislocations than type 2 AC joint dislocation, male predominance was seen with major causal factor to be Road traffic accident„ among males & females the dominant limb (i.e., right upper limb)involvement was seen, patients were evaluated at 4, 6 & 12 weeks intervals using CONSTANT score. 17 patients had excellent results with near normal range of shoulder movements, 4 had good results due to mild restriction of movement & pain, 2 had poor results that were due to hematoma & infection in one patient which was treated according to culture sensitivity of the organism & antibiotics, another patient had stiffness & pin migration for which implant removal was done. Following which regular mobilization was started. Conclusion: After conducting this study we arrived at an inference where AC joint injuries do contribute to major morbidity for the patient in view of altered shoulder biomechanics which resulted in loss of shoulder movements & affecting day to day activities. Hence an AC joint injury has to be addressed surgically as early as possible to make patients return to their pre injury status. Tension band principle also has the advantage of being cost effective, short surgical time and early rehabilitation. Keywords: AC joint dislocation, Tension band wiring, Constant score.

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