ACL (anterior cruciate ligament) ligament is one among 4 major ligaments of the knee, three other being, PCL (posterior cruciate ligament), MCL (medial collateral ligament) and LCL (lateral collateral ligament).Since the ACL runs from front on leg bone (tibia) coursing back to attach on thigh bone (femur), it will be stretched when the tibia moves forwards on femur. Hence, this ligament functions to provide the knee stability in the antero-posterior direction. ACL prevents the tibia from displacing forwards on femur. Thus, its prime role is to stabilize the knee in the sagittal plane of the body.How it is torn?Tear of ACL occurs most commonly during sports and accidents which involve sudden buckling of the knee (sudden change in direction due to force)1. When you land inappropriately from a high jump.2. When sudden force is applied on the front of the knee3. Sudden change in direction while the foot is planted on the ground.4. In India road traffic accident is the most common cause of ACL tear.Sign and Symptoms:Most patients present with complaints of knee pain and swelling following a knee injury. Swelling is abrupt in case of cruciate ligament tears as there is a blood collection from tearing of vessels that stretches the knee capsule, the most pain sensitive structure in the joint.When these patients present a few days after the injury, they may give a history of a pop or a click. The patients with cruciate ligament tears tend to have an extra sagittal motion in their knee that can present with a sensation of giving way of the knee. They express a feeling of buckling or instability in the knee (as the knee would dislocate) if they try to run or stress their knees. In patients with any clinical signs suggestive of ligament disruption, a good clinical examination is mandatoryClinical ExaminationOn suspecting ACL tear your clinician will examine your knee joint. Lachman test is most sensitive test to detect ACL injury. In this test sports injury specialist will check excessive motion of leg bone on thigh bone.

Arthroscopic surgery is minimally invasive procedure which is done to see inside the joint to diagnose and treat the joint disorders. In this surgery a tube like arthroscope is inserted into the joint via a key hole to see inside the joint. Arthroscope is attached to a camera and a light source to see inside the joint. It is done under anesthesia general or spinal. Prof Takagi (1888–1963) of Tokyo University was the first person who done diagnostic arthroscopy of knee joint in 1918. Today knee arthroscopy is one of the most commonly done orthopedic surgeries.Prior to the widespread clinical use of arthroscopy and its specialized instrumentation, joint surgery required extended incisions for exposure and treatment of joint pathology. Arthroscopy offers several advantages over such extended open incisions. Compared with minimally invasive arthroscopic procedures, the extended exposure of joints prolongs recovery and increases pain and risk of complications, such as infection and stiffness. Minimally invasive surgeries, in general, result in less pain and postoperative swelling than open techniques. As a result, arthroscopically treated patients tend to heal faster and begin rehabilitation earlier and, subsequently, return to normal activity and work sooner.Why arthroscopic surgery?Advantages of arthroscopic surgeries over open surgeries:-1. Small incisions and scars. Usually stab incisions are given for making portals which heal with minimal scarring2. Less postoperative pain3. Faster rehabilitation and faster return to work : Selected arthroscopic procedures can be performed under local anaesthesia4. Reduced hospital stay:5. Making the diagnosis: Diagnosis based on clinical examination alone is not always accurate, as the tests have certain limitations. Many a times, when the patient presents with an acute injury, due to pain clinical examination is virtually impossible. MRI too can give false positive findings. Arthroscopy is the gold standard in diagnosis of knee injuries.6. Reduced complication rate.

First episode of shoulder dislocation is mostly traumatic in nature. In most of the cases it can be reduced by manipulation by an orthopedic surgeon. After that it should be stabilized in a shoulder immobilizer for 7-10 days. This rest will allow soft tissues around the shoulder to heal. Gradually exercises should be started to get range of motion first and then strength of shoulder muscles. Proper and early rehabilitation is very important to prevent shoulder stiffness.Chances of recurrent shoulder dislocation after first episode are very high in young patients (20-30 years). In patients around 20 years chances of recurrent shoulder dislocation are so much that surgery should be done even after first dislocation to prevent further dislocations. By definition dislocation episode more than one is recurrent shoulder dislocation. The younger the age at first dislocation, the higher the chances the patient may come back with recurrence.What happens in shoulder dislocation: Shoulder is inherently unstable joint in which large head of arm bone (humerus) fits into shallow socket (glenoid ). When a shoulder dislocates soft tissue around socket known as the labrum gets torn. Torn labrum is most common cause of recurrent shoulder dislocation. Apart from labrum tear bone damage from head of humerus and glenoid may also occur during shoulder dislocation and this may also cause recurrent shoulder dislocation. Thus the two most common cause of recurrent shoulder dislocation are:-1. Torn labrum2. Bone loss from head of humerus and/or glenoidShoulder Dislocation Management:Arthroscopic surgery for recurrent shoulder dislocation: MRI and CT scan should be done to see torn labrum (MRI) and bone loss from head of humerus and glenoid cavity (CT Scan)Treatment of labral tear is done by arthroscopic repair of labrum. Open procedures are sometimes required if significant bone loss of head of humerus or glenoid are present.Arthroscopic treatment of shoulder dislocation: It is done by a video camera so only 1cm size incisions are given and shoulder joint is not opened. In this surgery torn labrum is again reattached to the glenoid cavity using special small suture anchors. Recovery is quick and patient can be discharged next day.Patient preparation before surgery:Day before surgery you are admitted to hospital for some blood investigations, ECG and chest X ray. In the old age ECHO may be required. Surgery for recurrent shoulder dislocation can be done under regional anesthesia or general anesthesia for which you have to be fasting for 8 hours before surgery. Hairs from the operating site are removed in the operation theatre before surgery.Risk of surgery:Infection, nerve Injury, shoulder stiffness, decreased shoulder range of motion ( external rotation of shoulder is decreased after Latarjet procedure).