ACL Tear

The ACL (Anterior Cruciate Ligament ) is an important ligament of the knee Joint that holds the two bones of the two bones of the knee together & prevents forward displacement during normal day – activities & sports.

How ACL may get inured during bike accidents or during sports. In former instance twisting of the knee joint forcefully  & landing on the outer aspect of the knee is responsible for the injury & in the latter instance it is mostly due to cutting maneuvers & direct tackling e.g. in football, cricket.

 Most people report hearing a “pop” sound at the time of injury Rapid swelling of the knee joint & Inability to bear weight on the affected limb follows this up.  There is pain in the affected knee & all movements are limited.

The affected person loses confidence in the limb. Simple activities  like running , climbing stairs, jogging etc. Become challanging . There is a feeling of instability &sportsman have to give up their sports. Even non- sportsmen have to accept a low profile sedentary lifestyle for the rest of their lives.

The limb is rested in a brace & ice is app is applied to decrease the swelling, Painkillers are prescribed & the patients is advisor to use crutches for ambulation 1-2 weeks, Gentle physiotherapy is started & activities are resumed gradually.

This surgery now become minimally invasive as it is done within Small (6mm) incisions that required for the arthoscope. Additional small incision is given to take  the graft from patient own leg the advantage of the Arthroscopic procedure oven one  is the improved surgical accuracy, faster recovery & hence & better clinical outcome. The graft is passed the bones by means of small tunnels & fixer with special screws. The graft procedure is observed with the camera so as to achieve the highest possible accuracy.

Operation time 1 to 2 hour most of the patient will come back from anaesthesia effect in two hours.

After operation little pain is natural, but it will be different from patient to patient. All the possible efforts should start before & after operation to reduce pain, when you are in hospital, you can inform staff, they will give you  medicine to reduce pain.

Yes, if one wishes to lead a normal life & pursue &   sports,  surgery is the only way out.

Initially one may be able to manage with some difficulty but later on there is premature onset of severe crippling painful arthritis in the middle age, which ,will eventually require major joint replacement surgery.

 Bed rest is required only on the day of surgery. the patient can walk bearing full weight on the very next day knee bending  exercises are started. Crutches are advise for a fortnight after Which they can be gradually discarded.

This will take approximately 2-3 months. The Time Required by the graft to  Get fully incorporated in the bony tunnels. However complete recovery differs  from patient to patient.

Yes, you can ice use but  not direct. ice slice in one bag or  clothes and for 20 Minutes after every hour after you wake up.

 You should not take direct bath until and unless your stitches not removed,  but  can use warm spunch to clean skin near stitches but stiches should not     become wet.

You can sit crossleg  or squat after three months (not before).

If your work is with siting then when you are feeling comfortable . your work need some physical stress, than you have to talk with Dr. Deliwala.

Again about this you have to talk with Dr. Deliwala usually for sports game it need 6 months.

When you are comfortable & protected to drive vehicle , you can drive. In beginning you can try to drive in large space, After 3 months you can use 4 wheeler or 2 wheeler without gears and after 6 months you can use 2 wheeler with gears.

After giving operation date & first week after operation you should meet your Physiotherapist.

After Discharge from hospital, You have to follow Dr. Deliwala sir time table for re check up.

Rotator Caff Tear

The rotator cuff is a group of four muscles that come together as tendons to form a “cuff” over the head of the humerus (upper arm bone). The four muscles—supraspinatus, infraspinatus, subscapularis and teres minor—originate from the scapula (shoulder blade). The rotator cuff tendons attach to the head of the humerus in special spots referred to as the greater and lesser tuberosities.

The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.

The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm.

A rotator cuff tear may result from an acute injury, such as a fall, or may be caused by normal age-related wear and tear with degeneration of the tendon.

Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching. You may feel pain when you try to sleep on the affected side. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back.

If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm.

Front view (left) and overhead view (right) of the tendons that form the rotator cuff. The blue arrows indicate a full-thickness tear in the supraspinatus tendon, the most common location for rotator cuff tears.

A rotator cuff tear can extend or get larger over time. This can occur with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear.

If you know you have a rotator cuff tear, then worsening pain and decreasing strength may mean the tear is getting larger.

If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see your orthopaedic surgeon. He or she can then make a diagnosis and begin treatment. Your doctor may recommend a diagnostic imaging study such as a magnetic resonance imaging (MRI) scan or an ultrasound to confirm the diagnosis.

Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in.

If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment.

Many rotator cuff tears can be treated nonsurgically. Anti-inflammatory medication, steroid injections, and physical therapy may all be of benefit in treating symptoms of a cuff tear. The goals of treatment are to relieve pain and restore strength to the involved shoulder.

Even though most tears cannot heal on their own, good function can often be achieved without surgery.

If, however, you are active and use your arm for overhead work or sports, then surgery is most often recommended because many tears will not heal without surgery.

Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm.

Surgery is also indicated in active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.

The type of repair performed is based on the findings at surgery. A partial tear may require only a trimming or smoothing procedure called a débridement. A full-thickness tear within the substance of the tendon can be repaired side to side. If the tendon is torn from its insertion on the humerus (the most common injury), it is repaired directly to bone.

Three techniques are used for rotator cuff repair: traditional open repair, mini-open repair, and arthroscopic repair.

Your orthopaedic surgeon can recommend which technique is best for you.

Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear.

When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder.

Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed. Complete rehabilitation after surgery may take several months.

Your orthopaedic surgeon can prescribe an appropriate program based on your needs and the findings at surgery.