Successful ACL Reconstruction and Meniscal Repair Relieved Pain and Instability in a 23 Y.O. Male

PACE Hospitals’ expert Orthopaedic team successfully performed Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction with lateral meniscal balancing on the right knee of a 23-year-old male patient who had presented with complaints of pain and instability in the joint. The procedure aimed to restore knee stability, relieve pain, and improve overall joint function, enabling the patient to regain mobility and return to his regular activities.

Chief Complaints

A 23-year-old male patient with a body mass index (BMI) of 23 presented to the Orthopaedics Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of persistent pain and instability in his right knee, associated with difficulty performing daily activities. These symptoms developed following a twisting injury sustained while playing badminton.

Past Medical History

There was no documented history of other chronic conditions, such as diabetes, hypertension, or liver disease, at the time of admission.

On Examination

On examination, the patient was conscious, coherent, and well-oriented to time, place, and person, with stable vital signs. There was no pallor, icterus, lymphadenopathy, clubbing, or cyanosis noted. Local examination of the right knee revealed joint effusion and tenderness along the medial joint line. No distal neurovascular deficits (DNVD) were observed.

Diagnosis

Following the clinical examination, the Orthopaedics team conducted a comprehensive assessment, including a detailed review of the patient’s medical history and a focused evaluation of the right knee joint.

To confirm the diagnosis and evaluate the extent of internal derangement, a comprehensive clinical and systemic examination was performed. Initial X-rays of the right knee were obtained to rule out any fractures or bony abnormalities and to assess joint alignment. Although X-rays showed no bony injury, the patient exhibited right knee effusion, medial joint line tenderness, and positive special tests, including the anterior drawer test and McMurray test for the lateral meniscus. These findings were suggestive of an anterior cruciate ligament (ACL) tear and a bucket handle tear of the lateral meniscus. Subsequent MRI imaging was performed to confirm the diagnosis and assess soft tissue damage in detail.

Based on the confirmed diagnosis, the patient was advised to undergo Anterior Cruciate Ligament and Lateral Meniscus Tear Treatment in Hyderabad, India, under the care of the Orthopaedic Department, ensuring comprehensive management.

Medical Decision Making

After a detailed consultation with Dr. Raghuram, Consultant Orthopaedic Surgeon, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history, clinical presentation, and imaging findings, a thorough assessment was carried out to devise an optimal treatment plan.

Based on the clinical examination and confirmatory imaging, which revealed an anterior cruciate ligament (ACL) tear and a bucket handle tear of the lateral meniscus in the right knee, it was determined that arthroscopic ACL reconstruction combined with lateral meniscal balancing was identified as the most effective intervention to restore knee stability, reduce pain and instability, and improve joint function to enable the patient to resume daily activities and physical pursuits.

The patient and family members were thoroughly counselled regarding the diagnosis, the proposed surgical procedure, its benefits, potential risks, and the expected postoperative rehabilitation process to ensure informed consent and active participation in recovery.

Surgical Procedure

Following the decision, the patient was scheduled to undergo arthroscopic ACL Reconstruction Surgery in Hyderabad at PACE Hospitals, combined with lateral meniscal balancing under the supervision of the expert orthopaedic Department.

The following steps were carried out during the procedure: 

• Patient Preparation and Anesthesia: The patient was positioned supine on the operating table and administered spinal anesthesia. A tourniquet was applied to the right thigh to control bleeding during the procedure.

• Diagnostic Arthroscopy: A diagnostic arthroscopy of the right knee was performed, which revealed anterior cruciate ligament (ACL) insufficiency and a bucket handle tear of the lateral meniscus. The joint was thoroughly inspected to assess the extent of the injuries.

• Graft Harvesting: The medial hamstring tendons were harvested from the patient’s right leg to be used as the graft for ACL reconstruction.

• ACL Reconstruction and Meniscal Balancing: The ACL reconstruction was performed using a Syronix TightRope and Endobutton fixation on the femoral side and a T-button on the tibial side to secure the graft. The bucket handle tear of the lateral meniscus was addressed with arthroscopic meniscal balancing to restore meniscal function and knee stability.

• Closure and Postoperative Care: Intraoperative knee stability was assessed to confirm successful reconstruction. The wound was closed in layers using Vicryl sutures and staples. Finally, a compression bandage was applied to reduce swelling and support the surgical site.
  

Postoperative Care

The postoperative period was uneventful. The patient was mobilised and encouraged to walk during the hospital stay. Adequate antibiotics, analgesics, and supportive care were administered. Wound dressings were regularly done and remained clean throughout. The patient was stable at the time of discharge.

Discharge Medications

Upon discharge, the patient has been prescribed a short course of antibiotics to prevent the infection, along with digestive enzymes and anti-inflammatory agents to reduce inflammation and aid digestion. A stomach acid suppressant was included to protect the gastrointestinal tract. For cardiovascular protection, an antiplatelet agent and a cholesterol-lowering medication have been prescribed. Nutritional support was provided to address anemia and vitamin C to boost immunity and improve iron absorption.

Advice on Discharge

The patient was advised with physiotherapy focusing on walking and staircase training for 1 week to enhance mobility, balance, and strength. Additionally, a normal diet was recommended.

Emergency Care

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, leg pain, and vomiting.

Review and Follow-up Notes

The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after one week for further evaluation.

Conclusion

This case highlights a young male patient who sustained an anterior cruciate ligament (ACL) and lateral meniscus tear in the right knee following a sports-related injury. He underwent successful arthroscopic ACL reconstruction and lateral meniscal balancing. The postoperative period was uneventful, with good recovery and mobilization during hospital stay. The patient was discharged in stable condition with advice for physiotherapy, medication, and follow-up care.

Orthopaedic Department | Orthopedic Hospital in Hyderabad