The knee joint is one of the most complex joints in the human body, and the anterior cruciate ligament – ACL is often subject to injuries. The knee joint is the main part of the lower extremities, which make everything work in perfect order – from upright gait, support, cushioning of the steps, but also giving the basic characteristics of the gait itself. Due to its complexity, the joint is very often exposed to injuries, for the treatment of which sometimes surgical intervention is necessary.
Patient: “ My name is Nikola Malbaša and I am 42 years old. I was injured during mountain climbing three months ago. I am actively involved in sports. I came to Dr. Vladan Stevanović through an acquaintance. I also heard from a friend who, shortly before my injury, also had surgery at Atlas General Hospital. He had the same pain as me, so I opted for Dr. Stevanovic and Atlas Hospital. ”
Conversation with the patient before surgery
How did the injury occur and what issues did you have?
Nikola Malbaša: “ I fell and my knee simply fell out of socket. After that, I was immediately transported to Belgrade, since the incident happened abroad. At that time, nothing seemed serious, there were no fractures. Magnetic resonance imaging subsequently determined that my anterior cruciate ligament had been damaged. I also had damage to the meniscus and other ligaments in my knee. ”
Is the anterior cruciate ligament repaired only by this method?
Nikola Malbaša: “No. Since I am actively involved in sports, this is one of the ways to save my knee and continue playing sports. Also, this is a way to keep my knee stable for life in later years. ”
Are you familiar with the after surgery protocols and how much you will not be able to train?
Nikola Malbaša: “We haven’t talked much about it, but we will definitely talk about the details. I know that there is a detailed protocol related to physical therapy, but one thing at a time. First knee surgery, then everything else. I am disciplined about everything. I was also in the period of preparation and physical therapy, to strengthen my leg for this procedure. ”
Do you know what anesthesia you will be undergoing?
Nikola Malbaša: “Block anesthesia.”
Do you know everything about this operation?
Nikola Malbaša: “Yes, I know everything.”
The patient is completely relaxed, he is in safe hands and he knows that the anterior cruciate ligament will be repaired and that the intervention will solve all his problems and enable him to play sports again. He is completely familiar with the surgical procedure, and surgeon Vladan Stevanović told us about the frequency of such injuries and their treatment.
Ass Dr. Vladan Stevanović: “ A large number of our patients are going through sports trauma. These may not be the professionals we see at sports matches, but a large number of recreational players want to stay in good shape, they want to return to their activities and sports. Athletes often injure their knees. This patient has an injury of the anterior cruciate ligament. This ligament is extremely important for the stability of the knee, especially with some requirements such as various changes of direction, sports activities or some recreational activities, for which their knees and their stability are necessary. ”
Anterior cruciate ligament – reconstruction
Ass Dr. Vladan Stevanović: “ We will take one tendon from the patient called the semitendinosus, from which we will make a new anterior cruciate ligament. We will fix it in the knee with certain techniques, in a slightly specific way. It is done with a small incision, a small opening, the so-called all inside technique where everything will be performed inside the knee, under the control of the camera and our instruments. The advantage is that we take only one tendon, from which we make a very high-quality graft, and we leave other tendons that guard the hamstrings and still enable very fast and good rehabilitation and function. ”
Which anesthesia did the patient choose for the anterior cruciate ligament operation?
Ass Dr. Vladan Stevanović: “We agreed that it would be local anesthesia, the so-called ischiofemoral block. The patient will be awake in some way and will be able to monitor the intervention on the monitor. Also, we can discuss with him during the intervention, show him the course of the intervention itself, some of the procedures and procedures that we carry out and the patient can observe them on the monitor. I think that this type of anesthesia is very good for athletes and active people, it is easier to bear, they return to function faster and they can leave the hospital in the next 24-48 hours. ”
Arthroscopic surgery has become the standard in Serbia, it is constantly improving. This operation is a step higher in the application of arthroscopic surgical methods.
Ass Dr Vladan Stevanović: “ This technique is not completely standardized in everyday work, but we are working on making it. It is excellent because only a small part (we take from the patient) of the tendon and muscles (his autograft) is used. We apply fixation methods that reduce the possibility of loosening of that graft. We can control everything and enable much better work during the operation, both for ourselves and for the patients. ”
How many surgeons do we have today who can successfully apply this method?
Ass Dr. Vladan Stevanović: “ Through constant practice and improvement, education, there will be more and more of them. We are working on applying all the techniques that have already been confirmed in the world and that have their followers and have proven to be effective. Of course we do not accept everything new that appears. We always wait for the technique to be checked, as it really looks in world of science, and then we have the opportunity to apply it to our patients, which brings benefits to all of us together. ”
The patient is on his feet soon after the operation. In order for the intervention to have the best effect on the patient, during the recovery, which is not a short period, it would be best for the patient to be disciplined and to respect everything that the doctors advise him.
Ass Dr. Vladan Stevanović: “ The patient is going through intensive rehabilitation period. He needs to respect it completely. We no longer tell patients that they will have a safe rehabilitation of a few months. What is safer is the period from 9 months to 12 months for them to return safely to all the activities they want to practice.
The first three months are extremely important to respect. It is necessary that the graft that we make and which is implanted instead of the natural anterior cruciate ligament, is biologically accepted in the knee. This is no longer natural in any case anyway. That is why we use certain biological methods of support. With their help, we can help the graft to grow and ligamentise faster and with better quality. We give some new information to the knee with certain substances, in order to achieve such a biological growth.
Be careful, watch your knee. If you injure it or the degenerative changes take their toll, experienced and professional surgeons can restore your knee to its previous state in the least invasive way. ”
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