Successful Arthroscopic ACL Reconstruction & Meniscus Repair for ACL Tear with Lateral Meniscus Tear in a 25 Y.O. Male

Chief Complaints

A 25-year-old male patient with a body mass index (BMI) of 22 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain in the right knee, associated with difficulty in performing daily routine activities and a sense of instability, particularly while climbing stairs, following a history of self-fall from a bike.

The patient was a known case of diabetes mellitus. There was no history of known drug allergies, and no other significant past medical or surgical history was reported.

On examination, the patient presented with right knee joint tenderness, predominantly over the anterior joint line, along with marked restriction of range of motion due to pain. Special tests revealed a positive anterior drawer test, positive Lachman test, and positive pivot shift test, indicating anterior cruciate ligament insufficiency. The McMurray test was also positive, suggestive of associated meniscal injury.

There was no evidence of varus or valgus instability, and the posterior drawer test was negative. The patient demonstrated painful and restricted terminal flexion of the knee with associated functional instability. Generalized joint hyperextension was also noted involving multiple joints, including the knee, thumb, and elbow. Distal neurovascular status was intact with no deficits noted.

Following the clinical evaluation, the Orthopaedics team at PACE Hospitals conducted a detailed assessment focusing on the patient’s complaints of pain in the right knee associated with difficulty in walking, performing daily routine activities, and a sense of instability, particularly while climbing stairs, following a history of self-fall from a bike.

A comprehensive clinical and systemic examination was carried out to determine the severity of the condition. Examination of the right knee revealed tenderness over the anterior joint line with gross restriction of range of motion due to pain. Special clinical tests, including anterior drawer test, Lachman test, and pivot shift test, were positive, indicating anterior cruciate ligament insufficiency. The McMurray test was also positive, suggestive of associated meniscal injury. There was no evidence of varus or valgus instability, and the posterior drawer test was negative. There was no distal neurovascular deficit in the affected limb.

Radiological and arthroscopic evaluation confirmed a complete mid-substance tear of the right anterior cruciate ligament along with a complete radial tear of the posterior horn of the right lateral meniscus.

Based on these findings, the patient was diagnosed with a Right knee lateral meniscus posterior horn complete radial tear with a Right Anterior Cruciate Ligament mid-substance complete tear Treatment in Hyderabad, India, under the Orthopaedic Department to restore knee stability, preserve meniscal function, relieve pain, and improve overall functional outcome and quality of life.

Following the diagnosis, the patient was scheduled to undergo Arthroscopic Lateral Meniscus Repair followed by Right Anterior Cruciate Ligament (ACL) Reconstruction Surgery in Hyderabad at PACE Hospitals, using ipsilateral hamstring (semitendinosus) graft under the supervision of the expert Orthopaedic Department.

The surgical procedure involved the following steps:

• Anaesthesia, Positioning & Preparation: Under spinal anaesthesia, the patient was placed in a supine position on the operating table. A non-sterile tourniquet was applied to the thigh. All bony prominences were carefully padded to prevent pressure injuries. The surgical field was cleaned, prepped, and draped in a sterile manner. A time-out procedure was performed to confirm the correct surgical site, followed by administration and repeat dosing of prophylactic antibiotics.

• Diagnostic Arthroscopy & Injury Assessment: A diagnostic knee arthroscopy was performed using medial and lateral parapatellar portals. Intraoperative evaluation confirmed a complete tear of the anterior cruciate ligament and a complete radial tear of the posterior horn of the lateral meniscus. The joint was systematically inspected, and no additional intra-articular abnormalities were identified.

• Meniscus Repair Procedure: The torn lateral meniscus posterior horn was prepared by trimming and refreshing the tear edges. The meniscal tear was then repaired using Surestitch sutures (total 2 sutures) to restore meniscal continuity and stability, aiming to preserve meniscal function and reduce future degenerative risk.

• ACL Reconstruction Procedure: The ipsilateral hamstring tendon (semitendinosus graft) was harvested and prepared. Anatomical landmarks of the femoral and tibial ACL footprints were identified. Tunnel creation was performed using guide pins and sequential reaming of the femur and tibia. The graft was then passed through the tunnels and securely fixed using Sironix implants (adjustable loop titanium button, T button, fiber tape, and fiber wire), restoring anatomical alignment and knee stability.

• Final Assessment & Closure: Final arthroscopic inspection confirmed a well-tensioned ACL graft with no impingement (no PCL or notch impingement) and stable knee mechanics with a negative Lachman test. The joint was thoroughly irrigated to remove debris. The tourniquet was deflated, hemostasis ensured, and the incision sites (including graft harvest site) were closed using Vicryl sutures and skin staplers. A sterile dressing was applied, and the patient was shifted to SICU in a stable condition with no distal neurovascular deficit.

The operation was uneventful. Postoperatively, the patient was monitored in the SICU (Surgical Intensive Care Unit) for a few hours for vital signs and limb assessment. On postoperative day 1, the dressing was changed, and non-weight-bearing mobilization was initiated using a walker with a knee brace for protection. The patient had transient numbness in the right leg, which improved with conservative management. By postoperative day 2, there was no wound soakage, and symptoms had further reduced. He remained hemodynamically stable throughout the hospital stay and was discharged in stable condition.

The patient was discharged with medications prescribed for the prevention of postoperative infection, pain and inflammation control, and stomach protection to prevent irritation from the medication. Additional antimicrobial coverage was also given to manage any potential resistant infections. These were advised for a duration of five days with specific timing in relation to meals to ensure optimal effectiveness and tolerance.

The patient was advised to maintain strict non-weight bearing mobilization using a walker with a knee brace until further medical review. The surgical dressing should be kept clean and dry and should not be exposed to water. Ice application is recommended at regular intervals to reduce pain and swelling. The patient was also instructed to continue physiotherapy exercises including knee extension, quadriceps strengthening, calf pump exercises, and structured ACL and meniscus rehabilitation protocol.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as severe pain in the operated knee, increasing swelling, redness or discharge from the surgical site, fever, numbness or weakness of the limb, or any difficulty in mobility.

The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after 5 days for dressing change in the OPD, with a prior appointment, and for further evaluation and planning of the physiotherapy regimen.

This case highlights a traumatic right knee injury with complete ACL tear and complete radial tear of the lateral meniscus posterior horn. The condition was managed with arthroscopic meniscus repair and ACL reconstruction using ipsilateral hamstring graft. Postoperative recovery was uneventful with stable clinical status and improving symptoms. The patient was discharged in a stable condition with planned rehabilitation and follow-up.