Anterior Cruciate Ligament (ACL) Tears
The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is located in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.
An ACL injury is a sports related injury that occur when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.
When you injure your ACL, you might hear a “popping” sound and you may feel as though the knee has given out. Within the first two hours after injury, your knee will swell and you may have a buckling sensation in the knee during twisting movements.
Diagnosis of an ACL tear is made by knowing your symptoms, medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament, and arthroscopy.
Treatment options include both non-surgical and surgical methods. If the overall stability of the knee is intact, your doctor may recommend nonsurgical methods. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.
Young athletes involved in pivoting sports will most likely require surgery to safely return to sports. The usual surgery for an ACL tear is an ACL reconstruction which tightens your knee and restores its stability. Surgery to reconstruct an ACL is done with an arthroscope using small incisions. Your doctor will replace the torn ligament with a tissue graft that can be obtained from your knee (patellar tendon) or hamstring muscle. Following ACL reconstruction, a rehabilitation program is started to help you to resume a wider range of activities.
Gluteus Medius Tear
Gluteus medius is one of 3 muscles in the buttocks and is situated on the outer surface of the hip. The function of the gluteus medius is to assist with pelvis stability, hip abduction, along with internal and external rotation of the hip. Tears of the gluteus medius usually occur where the tendon inserts at the greater trochanter, causing lateral hip pain.
Tears of the gluteus medius can occur due to traumatic injury or degenerative conditions such as tendinopathy (chronic inflammation of the gluteus medius tendon). Gluteus medius tears cause pain and weakness on the affected side of the hip.
Initial treatment involves ice, non-steroidal anti-inflammatory drugs (NSAIDs) and activity modification to decrease pain and inflammation. If a severe, full-thickness gluteus medius tear is present, surgical repair may be required.
Gluteus medius repair surgery involves the following steps:
- You will be placed either under general anaesthesia or spinal anaesthesia.
- The surgeon makes two or three small incisions, about 1/4 of an inch each, around the hip joint area. Each incision is called a portal. Mid anterior, anterolateral, posterolateral, and distal peritrochanteric portals are made.
- A blunt tube, called a trocar, is inserted into each portal prior to the insertion of the arthroscope and surgical instruments.
- The arthroscope is inserted through the mid- anterior portal, to view the hip joint. The images from the arthroscope guide the surgeon and assist in detection of any anomaly. It also enables the surgeon see the attachment of the gluteus medius muscle.
- The surgeon conducts a diagnostic endoscopic examination of the peritrochanteric space.
- The other portals are used for the insertion of surgical instruments.
- Debridement of the tears on the under surface of the gluteus tendon and pathologic tendon tissue is performed using a shaver.
- The tear at the lateral facet of the greater trochanter is identified and removed using a bur to stimulate active bleeding which would aid in healing of the repaired .
- The tendons are visualized and an anchor(s) is/are placed onto the greater trochanter of the femur and a suture is passed through the ruptured tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone.
- After the surgical procedure is completed, the incisions will be closed with sutures or surgical tapes.
Hip Labral Tear
Labrum is a ring of strong fibrocartilaginous tissue lining around the socket of the hip joint. Labrum serves many functions where it acts as shock absorber, lubricates the joint, and distributes the pressure equally. It holds the head of the femur in place and prevents the lateral and vertical movement of the femur head with in the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.
Labral tear may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is one of the rare conditions and is common in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause hip labral tear. Patients may have hip pain, clicking and locking of joint and restricted range of motion. Patients may also experience dull pain on movement of hip joint that may not subside on rest. Hip labral tear is often diagnosed with symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing hip labral tear.
Your doctor may start with conservative treatment prescribing non-steroidal anti-inflammatory drugs and advising you to rest. These methods may offer symptomatic relief while surgery is required to repair the torn labrum. Your doctor may perform arthroscopic surgery using fiber-optic camera and surgical instruments through the smaller incisions. Depending on the severity of tear, the damaged or torn labrum may be removed or may be sutured.