Understanding ACL, MPFL and Osteotomy Knee Surgeries - Causes & Treatments

The knee joint is one of the most crucial junctions in the human body as it connects the shinbone, the thigh bone and the fibula bone, which form our legs. The knee joint is responsible for providing strength, stability, turning, and smooth mobility of the entire limb by holding the three long bones of the leg with the help of thread-like ligaments and a kneecap.

Two of these ligaments, i.e. anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), are placed inside the knee and control the lateral angular movements of the knee joint. The other two ligaments, i.e. Medial collateral ligament (MCL) and Lateral collateral ligament (LCL) are placed on the sides of the knee which control the side angular movements for the knee. Apart from these ligaments, there is another ligament called ‘Medial Patellofemoral Ligament (MPFL)’ which holds the inner knee cap together with the thigh bone.

These ligaments are incredibly crucial for helping the legs in performing routine tasks like walking, jumping, turning, sprinting, etc.

However, due to various reasons, these ligaments get damaged, torn or strained and sometimes require surgical procedures for rectification. This most commonly occurs in athletes

Let’s discuss the three most common Ligament problems and their treatments in detail:

ACL Tears and its Treatment:

Due to extreme strain on the knee, the ACL tears off and both it’s attached ends break and fall off. The severity of this tear can be diagnosed only after an extensive physical examination along with proper analysis of the patient’s past medical history. And the patient might fall into the following three categories;

• The patient feels extreme pain and won’t be able to perform everyday tasks like walking, sitting, jumping, etc. efficiently. They also feel the knee bones slipping from their original position, also known as a ‘Trick Knee’.
• Despite the ACL tear, the patient can perform all everyday tasks smoothly without any pain.
• The patient can perform everyday tasks but may face a ‘trick knee’ condition in the future.

As the broken ACL edges cannot be reattached, based on the diagnosis, the patient has two options to go for ACL tear treatment:

Surgical Treatment:

• Here, an arthroscopic Reconstruction Surgery is performed on the ACL tear where a tendon tissue graft from your body is used as a replacement for the ACL.
• As per the reports, nine out of ten people who undergo this surgery never face ‘trick knee’ conditions again.
• But the downside of this surgery is the prolonged healing time of more than six months after which, the patient might also feel post-surgical stiffness.

Non-Surgical Treatment:

• If the patient isn’t feeling any form of pain or it seems that surgery isn’t entirely necessary, then the doctors treat their ACL tear either with a brace around the knee or various physical therapeutic exercises.
• This prevents the patient from undergoing surgery and the risks associated with it.
• However, as the occurrence of ‘Trick knee’ conditions is unpredictable, these treatments might fail and call for critical reconstruction surgery later on in the patient’s life.

MPFL Strains and its Treatment:

As the inner knee cap is kept in place by the MPFL ligament, any damage to the kneecap, in turn, damages this ligament too. Athletes who play sports that require rapid pivoting like football and cricket often encounter such strains. Hence, a direct knee dislocation will completely strain the MPFL, and it breaks.

Non-Surgical Treatment:

• For the patients, suffering from MPFL strain for the first time without any cartilage injury, doctors mostly suggest non-surgical treatments like NSAIDs and immobilization of the knee. The patient then has to perform different therapeutic exercises to strengthen the other muscles around the knee.
• Also, there is a risk of ligament healing in its stretched and loosened position, which creates more instability and becomes a severe problem.

Surgical Treatment:

• The surgical option of MPFL reconstruction is only suggested to a patient if;

• the patient has suffered from multiple kneecap dislocations
• the residue of broken cartilages or knee pieces are stuck inside the knee joint

• Here, first, the patient’s medical history is studied thoroughly along with a physical examination with the help of an MRI.
• An arthroscope is also used to check the surgical area for damaged cartilage and bone pieces.
• If possible, the surgeon tries to repair the ligament in its place or else replaces it with another tissue draft.
• MPFL reconstruction has one of the highest success rates with respect to other ligament surgeries. However, rares cases of infections, blood clotting, and additional fractures are also seen.

Osteotomy - causes and its Treatment:

Some people are born with leg bones which are misaligned or which became misaligned due to an accident. This puts severe pressure either on the outer part (lateral) or the inner part (medial) of the knee, ultimately leading to Osteoarthritis.

It becomes extremely difficult for the patient to walk with an osteoarthritis knee as it gets unstable and causes a lot of pain.

Osteotomy, which directly translates to ‘cutting the bone’ is commonly performed on patients suffering from osteoarthritis, also known as unilateral knee arthritis.

Surgical Treatment:

In this case, the only feasible option is to cutting or altering the shape of one of the two long bones, i.e. the thigh bone or the shinbone in such a way that it rests entirely on the secure part of the knee.

Based on the bone that is altered, an osteotomy can be performed in two ways;

High Tibial Osteotomy:

• It is performed by altering the shin bone.
• Here, the surgeon either adds or removes a small part of the tibia from just below the knee, which is closer to the knee joint.
• They are performed in the case of a bow-legged alignment where the knee moves outside from its original position on its axis by 15 mm or more, causing more wear and tear on the inside part of the knee.

Femoral Osteotomy:

• It is performed by altering the thigh bone.
• Here, the surgeon either adds or removes a small part of the femur from just above the knee, which is closer to the knee joint.
• They are usually performed on a knock-kneed alignment where the knee moves inside from its original position on its axis by 10mm or more causing more wear and tear on the outside part of the knee.
• This surgery also helps in improving the joint’s functions.

You can find a few good hospitals which provide osteotomy knee surgery in Mumbai.

Also if you’re an athlete looking to undergo an ACL or MPFL reconstruction surgery in Mumbai, remember that these surgeries also have good non-surgical, less risky options, hence, make sure to look for a surgeon who can guide you through those options too.

Dr Pranjal Kodkani is one of the best Orthopedic surgeons, specialized in ACL reconstruction surgery in Mumbai. He is well known for treating sports injuries along with a skilled and experienced career in joint preservation surgery.