The Knee Joint

Introduction The knee joint is most commonly involved in many sports injuries and as modern sport is being more and more competitive, more complex knee injury patterns are being recognized. Anterior cruciate ligament (ACL) is a very commonly involved ligament in these injuries.8 The knee joint is a large compound type of synovial joint. Due to the lack of bony support, stability of the joint is highly dependent on its supporting ligamentous structures, and therefore injuries of ligaments and menisci are extremely common especially in active individuals like athletes, labours and soldiers. Anterior cruciate ligament is an intra-articular, extra synovial structure present in the central complex of knee joint. It functions in

Broadly the mechanism of injury can be classified into two categories- contact and noncontact type. In India both of these types of mechanisms are involved in injuries in non sporting personnel resulting from sudden stepping down from bus, train, fall from stairs etc, and in individuals who is participating in traditional, sports like kabaddi, rural wrestling, kho-kho with cricket.11 Anterior cruciate ligament (ACL) is the major stabilizer of the knee, and its rupture is mainly associated to an indirect mechanism of trauma followed by hemarthrosis. The anterior instability may evolve to meniscal and chondral degenerative injuries. Symptoms of ACL injury may vary from just pain and Swelling to gross instability of knee joint, leading to reduced functional capacity and inability to take part in sports and productive activities. This may lead to poor quality of life, affecting the socio economic status of the

Arthroscopically assisted techniques for ACL reconstruction have resulted in smaller incisions without disturbing adjacent uninvolved anatomic structures. The recovery and rehabilitation following these procedures has also been shortened. The advantages to surgeons include visual enhancement and magnification of the intercondylar notch as well as assessing and treating associated articular cartilage and meniscus injuries.15

Various mode of fixation of graft are also available like Tran’s fixation device, end button, bio screws, ligament staples etc. To control rotatory instability number of authors has suggested reconstruction of not only antero-medial but also

Posterior -lateral instability. The double bundle ACL has wider contact areas between the bone and grafted tendon than a single bundle ACL via hamstring tendon, which means that only the margins of the tendon graft is anchored to collagen fibres resembling sharpey’s fibres and the tunnel wall in ACL reconstruction. However many studies in recent shown similar results and rotational stability even in single bundle reconstruction.