Minimally Invasive Ligament Construction in Children

Tuesday, July 21, 2009

Anterior Cruciate Ligament injuries are becoming increasingly common in the young active individual. MRI has also contributed significantly to the early diagnosis of these injuries. Treatment of ACL (Anterior Cruciate Ligament) injuries in the child and young adolescent remains controversial. This is especially so in the case of small children whose skeletons are yet to mature.

Any treatment plan must consider an assessment of the patients’ physical maturity, level of functional instability and identification of associated injuries. While a trial of non operative treatment may still be upheld by some, most reports of non operative treatment have demonstrated poor results. The natural history of the ACL deficient knee is one of recurrent episodes of giving way with resultant multiple meniscal tears and early degenerative arthritis.

Arthroscopic Reconstruction Transphseal Hamstring Graft

Arthroscopic ACL reconstruction is an elegant solution to this problem.Physeal sparing techniques have yielded poor results and therefore transphyseal techniques is one of the best solution to the problem.

The Hamstring tendon graft using semi tendinosus and Gracilis tendons or quadruped semi tendinosis graft provides an exceptionally strong and reliable graft. It has the added benefit of being harvested through a small unobtrusive incision. There is no post operative morbidity (as with B.T.B. graft) and the tendons grow back in time.

A quadrupled hamsting tendon provides 250% strength of the normal A.C.L. The most contemporary concept of double bundle grafting can only be affected with Hamstring tendon grafting.

Graft Fixation

Graft selection is the corner stone upon which optimal intra-articular ACL reconstruction is built; however graft fixation is important to allow early aggressive rehabilitation post operatively. Excellent initial graft fixation strength is essential for good graft tunnel bonding and therefore contributes immensely to the final outcome of this surgery. The first weeks are especially critical.

At the WOCKHARDT KNEE CLINIC we have been using the BIOTRANSFIX system for Femoral tunnel fixation with Bio-interference screw for tibial fixation with excellent results in 77 patients so far. The procedure is especially safe for young children who have significant growth left.

Dr. Gautaum Kodikal, M.S.
Consultant Orthopedic Surgeon
Department of Bone & Joint Care
Wockhardt Hospitals, Bangalore

Interventional Cardiologist at Bannerghata Road,Bangalore

Dr Subash Chandra
Consultant Cardiologist

Dr Chandra has over 27 years of experience in cardiology.He has worked at the The Royal Surrey County Hospital, Guildford, and at The General Infirmary, Leeds. He holds a degree in advanced fellowship in cardiology, he became an instructor in medicine and an attending physician (division of cardiology) at Cornell University Medical College and Hospital Cornell Medical Center, New York.

To view his detailed profile Click here

For scheduling an an consultation with Dr Subash Chandra click here

Dr. P. Ranganath Nayak
Consultant Cardiologist

Dr Nayak is one of the most experienced cardiologists in this region with over 25 years of experience in the field of cardiology.His special interest areas include complex coronary interventions, like chronic total occlusions and primary angioplasties
Dr Nayak is trained in interventional cardiology from Epworth Hospital, Melbourne, Australia and University Hospital, Rouen, France.

To view Dr Nayak's detailed profile Click here

For scheduling an an consultation with Dr Ranganath Nayak,Click here


Bookmark and Share