The 23-year-old international patient presented with pain in the right knee and difficulty in walking following injury about a year ago. He had sustained the multi-ligament injury and was treated conservatively in plaster and later with physiotherapy. He was unable to take part in any sports activity and pain in his knee was increasing in spite of wearing a knee brace and undergoing physiotherapy. On examination, there was marked wasting of his thigh and calf. He had mild swelling with minimal effusion. Anterior drawer test, posterior drawer test and anterior Lachman test and posterior Lachman tests were positive. The X-ray did not show any bony injury but MRI revealed a complete tear of both anterior cruciate ligament and posterior cruciate ligament tears.
Multiple ligament injuries of the knee joint is relatively rare and seen in road traffic accidents and sports injuries. The anterior cruciate ligament is a strong ligament measuring about 38mm in length and 10mm in width and comprises anteromedial and posterolateral bundles. the posterior cruciate ligament is approximately twice as strong and twice as thick as the normal anterior cruciate ligament. The posterior cruciate ligament is 38mm in length and is 13mm the width and has anterolateral and posteromedial bundles.
Clinically and radiologically his condition warranted stabilization and on 27th December 2020 combined arthroscopic ACL and PCL reconstruction was performed using hamstring tendons quadruple semitendinosus and gracilis graft from both legs. A patellar graft from the same side is the other option. The postoperative period was uneventful and he was discharged the next day. He underwent intense physiotherapy focusing on strength and flexibility of the knee joint considering that he had very severe wasting as he did not use his right lower limb effectively for almost one year. He is beginning to feel confident and able to walk without support or a brace. He is looking forward to playing his favourite sport football however he knows that he may well have to wait for another six months.
Dr. P Sharat Kumar,
MS (Ortho), M.Ch (Ortho UK), Dip. SEM, GB & I (IABSEM), MFSEM (UK) FFSEM (I) ,
Consultant Orthopaedic Surgeon,
Apollo Hospitals, Jubilee Hills, Hyderabad, India