Hyderabad|India|July'2011: KIMS adds another feather to its cap. Two of its Orthopaedic Surgeons Dr. Sunil Apsingi and Dr. Krishna Kiran Eachempati have performed a rare surgery - Anatomic Double-Bundle ACL Reconstruction for the first time in our state. They performed six surgeries on six different patients. This procedure has not been performed in our state before.

The anterior cruciate ligament, or ACL, is one of four major ligaments in the knee that provide stability to the joint. When a patient sustains a tear to the ACL, a sensation of instability, or giving out, may develop in the injured knee. This can lead to early arthritis in these young individuals. In order to restore stability to the knee, an ACL reconstruction is recommended to insert a new ligament in the place of the damaged ACL. Anterior cruciate ligament (ACL) reconstructions are one of the most frequent operations in young individuals. A new technique, called a double-bundle ACL reconstruction, has been developed to better replicate the function of the normal ACL.

Disclosing this addressing a press conference here in KIMS today, Dr. B. Bhaskar Rao Managing Director & Chief Executive Officer said six patients with ACL (Anterior Cruciate Ligament) injuries with significant instability were treated at Krishna Institute of Medical Sciences (KIMS) using anatomic double bundle reconstruction by Dr. Sunil Apsingi and Dr. Krishna Kiran Eachempati for the first time in our state. The double-bundle ACL is technically more demanding procedure when compared to the single bundle ACL reconstruction, and there are fewer surgeons with experience in this surgical technique in India and world.

Though single bundle provides good results in short term, it gets stretched after some years and the knee does not move normally as well. This could contribute to early knee arthritis. In anatomical double bundle ACL reconstruction a custom made reconstruction suiting individual’s native anatomy is performed. Hence an attempt is made to reproduce the normal anatomy of the patient unlike in single bundle reconstruction where in only a part of the ACL is reconstructed.

The philosophy of anatomical double bundle ACL reconstruction is to match ACL graft sizes to the patient's native anatomy. This means that normal knees stability and function is restored. Anatomic double bundle ACL reconstruction restores the knee joint's anatomy and alignment. The knee functions normally once the normal anatomy is restored. The most important goal of this surgery is to help patient maintain a long term knee health and reduce the incidence of early knee arthritis in these young patients- informed Dr. Sunil Apsingi and Dr. Krishna Kiran Eachempati.

For Anatomical Double Bundle ACL Reconstruction hamstring tendon graft from the thigh was used. An arthroscopic technique was employed old torn ACL was removed and two anatomical tunnels in the femur (thigh bone) and the tibia (leg bone) were created. The graft was passed through these tunnels and is fixed to the bone. The procedure lasted 60 to 90 minutes. Through this new technique, patients achieve excellent range-of motion, almost equal to the other knee. Results will be realized three months after the surgery.

The ACL connects the femur (thigh) bone to the tibia (leg) bone in the center of the knee joint. This ligament is commonly torn on twisting the knee during road traffic accidents or sports. ACL is important to discharge daily activities but absolutely critical to the stability of the knee while twisting the knee as in sudden turning. The ACL is made up of two functional bundles of tissue, the anteromedial (AM) and posterolateral (PL) bundles. These bundles are first seen during fetal development and persist throughout life. Each bundle has a different function, they together control the stability of the knee joint, informed Dr. Sunil Apsingi.

Adding further Dr. Sunil Apsingi and Dr. Krishna Kiran Eachempati said that ACL is one of four major knee ligaments. It is crucial for knee stability, and people who injure their ACL often complain of symptoms of their knee giving-out from under them. The ACL is important during daily activities but absolutely critical to the stability of the knee during twisting the knee as in sudden turning.

Adding further Dr. Krishna Kiran Eachempati informed that the knee ligament injuries are common among young people. The most common ligament injury is the ACL. These injuries can occur in isolation or associated with injuries to menisci and as a part of multi-ligament injuries which present as knee dislocations. The highest occurrence(Incidence) is in individuals between 15 to 25 years of age. ACL tears can occur at all ages and in all sporting activities.

This is a procedure established almost ten years and is widely practiced and used in countries like US and Japan. Japan was the first country to have developed this procedure. Now across the globe, hundreds of such surgeries have been done so far. In India, such surgeries are not heard before. Couple of surgeries have been performed in one of the southern states. Demonstration of surgeries with foreign doctors have been held before in India, but six surgeries are performed for the first time in the state of Andhra Pradesh three months ago. And the patients are doing very well. About sixty to seventy people in every 1000 population are prone to such knee problems.

The main advantage of a double-bundle reconstruction is that it is more precise in reconstructing what was torn. Individuals are born with 2 bundles. Why would anyone want a reconstruction that replaces only one of them? Double Bundle helps to restore 80-90% native ACL anatomy. It helps to maintain the long term knee health and reduce the incidence of early knee arthritis in this group of young and active individuals.

July.2011