SPORTS INJURY I Dr.RAJAT JANGIR JAIPUR #aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur #allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon To Know more about ACL Injury, Click the links below: 1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all" https://youtu.be/oWkIr8IXvr8 2. Everything about ACL Injury tear surgery in Hindi I https://youtu.be/bqpjkAkwZ14 3. Best Screw for ACL tear surgery in Hindi https://youtu.be/1LGpU1NHiIs 4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir https://youtu.be/SIAPWiMbOqs 5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ? https://youtu.be/NEJRPKskJTI 6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ? https://youtu.be/EXpgy19Jxzw 7. PRP injection therapy in Partial ACL TEARs https://youtu.be/qyG1EYgS87E Dr.RAJAT JANGIR(Asso Prof.) Senior Consultant Arthroscopy and Joint Replacement (Specialist in Shoulder Knee Hip Surgery) Ligament and Joints Clinic 67/34 Mansarovar Jaipur Whatsapp: shorturl.at/gnAEP Appointment: +91 8104855900 Email: ligamentsurgeon@gmail.com Google Page: https://g.page/KNEE-Shoulder-SURGERY?... Facebook: https://www.facebook.com/Ligamentandj... * Vast experience and specialisation in the field of Arthroscopy and sports surgery. * M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad * Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea * Diploma in Sports Medicine from InternationaI Olympic Committee * Invited as Athlete Medical Doctor at Rio Olympic 2016 * Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'

2. Articular Cartilage Injury
Dr.RAJAT JANGIR
Consultant Arthroscopy and Orthopedic Surgeon
Saket Hospital, Mansarovar
Assistant Professor
Mahatma Gandhi Medical College, Jaipur
Fellowship In Arthroscopy(South Korea)
International Olympic Committee Diploma Sports Medicine(UK)
Sports Physician RIO Olympic 2016

4.  Largest tendon in the
body
 Origin from
gastrocnemius and
soleus muscles
 Insertion on calcaneal
tuberosity

5. Lacks a true synovial
sheath-
 Paratenon has visceral
and parietal layers
 Allows for 1.5cm of
tendon glide

6. Paratenon
 Anterior – richly vascularized
 The remainder – multiple thin
membranes

7. Blood supply
1) Musculotendinous junction
2) Osseous insertion on calcaneus
3) Multiple mesotenal vessels on
anterior surface of paratenon (in
adipose)
– Transverse vincula
 Fewest @ 2 to 6 cm proximal
to osseous insertion

8.  Remarkable response to stress
 Exercise induces tendon diameter
increase
 Inactivity or immobilization causes
rapid atrophy
 Age-related decreases in cell
density, collagen fibril diameter and
density
 Older athletes have higher injury
susceptibility

9.  Gastrocnemius-soleus-Achilles
complex
 Spans 3 joints
 Flex knee
 Plantar flex tibiotalar joint
 Supinate subtalar joint
 Up to 10 times body weight through
tendon when running

10. 1. Close injury/rupture
2. Open injury/rupture
• Acute injury
• Neglected injury

11. 1. Accidental cut injury
(bath room injury, road
traffic injury)
2. Social/political
Violence

12. 1. Diagnosis and
assessment of extend
of injury.
2. Primary care
3. Operative treatment

13.  Pathophysiology
 Repetitive microtrauma
in a relatively
hypovascular area.
 Reparative process
unable to keep up
 May be on the
background of a
degenerative tendon

14.  Antecedent tendinitis/tendinosis in 15%
 75% of sports-related ruptures happen
in patients between 30-40 years of
age.
 Most ruptures occur in watershed area
4cm proximal to the calcaneal
insertion.

16. History
 Feels like being kicked in the leg
 Case reports of fluoroquinolone use,
steroid injections

17. Mechanism
Eccentric loading (running backwards in tennis)
Sudden unexpected dorsiflexion of ankle
(Direct blow or laceration)

19. Prone patient with feet over edge of
bed
Palpation of entire length of muscle-
tendon unit during active and
passive ROM
Compare tendon width to other side
Note tenderness, crepitation,
warmth, swelling, nodularity,
palpable defects

20.  Partial
Localized tenderness +/-
nodularity
 Complete
Defect
Cannot heel raise
Positive Thompson test

24.  Diagnostic Pitfalls
 23% missed by Primary Physician (Inglis
& Sculco)
 Tendon defect can be masked by hematoma
 Plantar-flexion power of extrinsic foot flexors
retained
 Thompson test can produce a false-negative
if accessory ankle flexors also squeezed

25. This lateral x-ray of the
calcaneus shows an
avulsion fracture at the
insertion of the Achilles
tendon, with marked
separation of fragments.
.

26.  Inexpensive, fast, reproducable,
dynamic examination possible
 Operator dependent
 Best to measure thickness and gap
 Good screening test for complete
rupture

27.  Expensive, not dynamic
 Better at detecting partial
ruptures and staging
degenerative changes,
(monitor healing)

28. Restore musculotendinous length and
tension.
Optimize gastro-soleous strength and
function
Avoid ankle stiffness

29. cast with
plantarflexion q 2 wks2 wks
Allow progressive weight-
bearing in removable cast
Remove cast and walk with shoe
lift. Start with 2cm x 1 month,
then 1cm x1 month then D/C
4 weeks
Start physio for ROM
exercises
When WBAT and
foot is plantigrade
Start a strengthening
program
2- 4 weeks

30.  Preserve anterior paratenon blood
supply
 Beware of sural nerve
 Debride and approximate tendon ends
 Use 2-4 stranded locked suture
technique
 May augment with absorbable suture
 Close paratenon separately

32.  Acute case : usually end
to end repair is enough
 Neglected case:
Advancement plasy (V-Y)
or reconstruction by
other tendons

36.  Assess strength of repair, tension and
ROM intra-op.
 Apply long leg cast with ankle in the least
amount of planterflexion(gravity equinus)
& knee 60 degree flexion with window at
operated site.
 Stitch removal after 2 wks.
 Short leg cast after 3 wks with partial
equinus correction

37.  2 weekly plaster change with gradual equinus correction (4-6
episode ).
 Walking with heel raised shoe & regular physiotherapy.
 Reverse ankle stop brace up to 6 months.