Successful ACL Reconstruction Using Hamstring Graft for Complete Tear of Left Knee ACL in a 29 Y.O. Male

PACE Hospitals’ expert Orthopaedic team successfully performed a Left Anterior Cruciate Ligament (ACL) reconstruction using an ipsilateral semitendinosus hamstring graft in a 29-year-old male patient diagnosed with a complete mid-substance tear of the left ACL. The aim of the procedure was to restore stability to the knee joint, improve overall function, and facilitate the patient’s return to normal physical activity and sports participation.

Chief Complaints

A 29-year-old male patient with a body mass index (BMI) of 23 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of left knee pain, difficulty performing daily activities, and a sensation of instability, particularly while climbing stairs.

Past Medical History

The patient reported a history of a twisting injury to the left knee approximately six weeks ago. There is no history suggestive of known drug allergies or any known chronic medical illnesses.

On Examination

On general examination, the patient was alert and oriented with stable vital signs. Physical examination of the left knee revealed tenderness over the anterior joint line and restricted range of motion with terminal pain on flexion. No distal neurovascular deficits were noted. Systemic examination was unremarkable, with normal findings in the respiratory, cardiovascular, abdominal, and neurological systems.

Diagnosis

Following the clinical examination, the Orthopaedics team at PACE Hospitals conducted a detailed assessment, focusing on the patient’s presenting complaints of left knee pain, instability while climbing stairs, and difficulty performing routine daily activities.

To confirm the diagnosis and determine the extent of the injury, a comprehensive clinical and systemic examination was performed. Clinical tests revealed tenderness over the anterior joint line, with a positive Lachman test, anterior drawer test, and pivot shift test, indicating anterior cruciate ligament (ACL) insufficiency. The McMurray, valgus/varus stress, and posterior drawer tests were negative. Range of motion was found to be grossly restricted with terminal pain on flexion, and distal neurovascular status remained intact. There were no associated findings suggestive of meniscal or collateral ligament involvement.

Based on these findings, the patient was advised to undergo Left Anterior Cruciate Ligament Tear Treatment in Hyderabad, India, under the care of the Orthopaedic Department, to restore joint stability, improve knee function, and enable a return to normal physical activities.

Medical Decision Making

After a detailed consultation with Dr. Anand Agroya, Senior Orthopaedic Consultant, a comprehensive clinical evaluation was carried out to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of a twisting injury to the left knee six weeks prior, along with symptoms of pain, instability while climbing stairs, and difficulty performing daily activities, a focused physical examination and clinical testing were performed. The findings suggested anterior cruciate ligament insufficiency, prompting further evaluation and planning for surgical intervention.

Based on the clinical assessment and intraoperative findings, which confirmed a complete mid-substance tear of the left anterior cruciate ligament, it was determined that ACL reconstruction using an ipsilateral hamstring graft (semitendinosus) was identified as the most suitable treatment to restore knee stability, improve joint function, prevent further intra-articular damage, and facilitate a return to pre-injury activity levels.

The patient and family members were thoroughly counselled regarding the diagnosis, proposed surgical procedure, potential risks, expected outcomes, and post-operative rehabilitation protocol. Informed consent was obtained after ensuring complete understanding and agreement with the planned treatment strategy.

Surgical Procedure

Following the decision, the patient was scheduled to undergo Left ACL (anterior cruciate ligament) reconstruction Surgery in Hyderabad at PACE Hospitals, using an ipsilateral semitendinosus hamstring graft , under the supervision of the expert orthopaedic Department.

The following steps were carried out during the procedure:

• Anesthesia and Preparation: The patient was placed in a supine position on the operating table, and spinal anesthesia was administered. After confirming adequate anesthesia and administering prophylactic antibiotics, the surgical site was prepped and draped in a sterile fashion. A non-sterile tourniquet was applied and inflated to minimize bleeding, and all bony prominences were padded for protection.

• Arthroscopic Evaluation: Using medial and lateral parapatellar portals, diagnostic arthroscopy was performed to evaluate the knee joint. A complete mid-substance tear of the anterior cruciate ligament (ACL) was confirmed, while the medial and lateral compartments, patellar cartilage, and femoral chondral surfaces appeared normal without abnormalities.

• Graft Harvesting: The ipsilateral hamstring tendons, specifically the semitendinosus, were identified and harvested through a small incision. The graft was prepared for reconstruction by cleaning and sizing it appropriately.

• Tunnel Preparation and Graft Fixation: The anatomical footprints of the ACL on the femur and tibia were identified and marked. Guide pins were inserted, and tunnels were drilled in both the femur and tibia with appropriate drill bits while the knee was hyperflexed to 135 degrees. The hamstring graft was then passed through the tunnels and fixed securely using Sironix implants (a fixed loop button and fiber wire). The graft was cycled before final fixation to ensure appropriate tension.

• Final Inspection and Closure: Arthroscopic inspection confirmed a well-tensioned graft with no impingement on the posterior cruciate ligament (PCL) or intercondylar notch. The knee demonstrated a full range of motion and stability, including a negative Lachman test. The surgical site was irrigated copiously to remove debris, the tourniquet was deflated, and the skin incisions were re-approximated.
  

Postoperative Care

The patient’s postoperative period was uneventful. He was shifted to the room following surgery. On postoperative day 1, dressing was done, and partial weight-bearing mobilization was initiated with the assistance of a walker and brace. During his hospital stay, he received intravenous antibiotics, analgesics, and other supportive treatments. He was discharged in a hemodynamically stable condition with prescribed medications and discharge instructions.

Discharge Medications

Upon discharge, the patient was prescribed a course of antibiotics to prevent postoperative infections, analgesics to manage pain and inflammation, and antacids to minimize the risk of gastrointestinal discomfort associated with analgesic therapy. These medications were intended to support postoperative recovery, promote healing, and ensure patient comfort during the initial recovery phase.

Advice on Discharge

The patient was advised to continue partial weight-bearing with a walker and brace, keep the dressing dry, and apply ice packs every four hours for 10 minutes. He was instructed to follow physiotherapy exercises, including knee extension, quadriceps strengthening, calf pumps, and the ACL rehabilitation protocol.

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 severe pain at operated site, discoloration and swelling of the operated site / limb Excessive bleeding / discharge from the operated site, chest pain, acute shortness of breath, altered sensorium, low urine output in the last 24 hours, nausea, vomiting, allergy / drug intolerance and, high grade fever.

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 5 days for dressing in OPD with prior appointment and further course of action pertaining to physiotherapy. 

Conclusion

This case highlights the successful management of a complete mid-substance tear of the left anterior cruciate ligament in a young male patient through arthroscopic ACL reconstruction using an ipsilateral hamstring graft. The surgery was uneventful, and the patient responded well to postoperative care. Early mobilization and physiotherapy were initiated to support recovery. The patient was discharged in a stable condition with appropriate follow-up and rehabilitation advice.

Orthopaedic Department | Orthopedic Hospital in Hyderabad