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Have ACL, PCL and MCL tear. Safe to go for total ligament repair and meniscus repair of knee?

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My 16 year old son needs a total ligament repair and possible meniscus repair of his knee. He has torn ACL,PCL,MCL and poss meniscus. I want to know the possible negative outcomes and if we should just go with the 1st surgeon we've seen to get it done sooner or wait and get another opinion to feel more comfortable knowing we have the best technical expert?
Posted Mon, 6 May 2013 in Bones, Muscles and Joints
Answered by Dr. Nirmala P 5 hours later

Thanks for asking in XXXXXXX

This triad of ACL, PCL and MCL tear usually occurs in either football or skiing injury.

Partial tear of cruciate ligaments is diagnosed more often through X-Ray or MRI because there may not be restriction of movements. But complete tear of ligaments severely limits knee movement impairing the twisting or turning movement of knee. Medical management like ice pack application, crepe bandage and elevation of knee and pain killers may help in partial tear but not in complete tear.

Surgery is not indicated in case of either partial tear or complete tear with no symptoms of instability. Being an adolescent, your son would like to be active and the limitation of movements due to ligaments tear limits his twisting or pivotal movement of knee and so he may need surgery if there is severe restriction of his day today activities.

Whenever there is severe functional instability to do routine activities then surgery is the only option. The epiphysis (growing end of long bones) fusion of tibia and fibula is around 19 years and that of femur is 21 years in boys. Since your son is only 16 years the risk of developing growth problems after surgery poses the difficulty in taking the decision about surgery. Also post operatively sometimes, there may be either too much or too less movement of knee.

So, it is always better to get a second opinion before opting for surgery as he is only 16 years and his epiphysis may not have closed.

I hope this helps.
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Follow-up: Have ACL, PCL and MCL tear. Safe to go for total ligament repair and meniscus repair of knee? 15 hours later
He is in pain. Has very little stability and is VERY active. He plays every sport in every season. The most destructive is football which I hate but we have had too many arguments and watched his grades slide when we said no. So he plays. Anyway regarding the epiphysis, will he need an additional surgery if this grows and begins to limit his range of motion? Or will he just have to live with the limitation? Does it just come down to weighing the two options? He cannot walk without a brace right know, so we may be talking years for final fusion in a brace ? Am I understanding this correctly?
Answered by Dr. Nirmala P 4 hours later

Thanks for coming back to our forum.

It is really nice to know that your son is a very active person and that is how an adolescent should be. It is always difficult for us to bear with anything happening to our children but do not worry, he will definitely become completely alright.

Combined ligamentous injury usually requires operative care. The decision is taken depending upon the grade of injury. In general, a complete tear occurs after the growth plate arrest. But the extent of injury can be assessed only by an orthopedician after complete examination.

MCL tear is most often treated non operatively wherein the knee is braced for 6 weeks with subsequent motion and strength exercises. But if instability remains then surgical treatment for MCL along with ACL and PCL reconstruction is recommended.

Treatment is based on age, activity level and degree of injury. Surgery is a better option than prolonged immobilization, instability and limitation of movements . Since knee is a weight bearing joint, he is in severe pain. Post operative physiotherapy exercises will strengthen his muscles and bring back his complete range of movement in due course of time.

In long bones, epiphysis is on both ends of the bone and is responsible for the longitudinal growth of bones. It does not overgrow and he does not need another surgery.

I wish and pray for your son's complete recovery and for further improvement in his grades. Good Luck.
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Follow-up: Have ACL, PCL and MCL tear. Safe to go for total ligament repair and meniscus repair of knee? 4 hours later
Thank you so very much for your knowledgeable answers and your kind thoughts and understanding. I have always been of the mind set what physical pain and difficulties I must endure I would always prefer than having anything happen to my children. We have scheduled the surgery due to his level of pain and severe restriction in mobility. He says it feels like jelly when he tries to walk without his brace on. My only fear remains 2 hours under general anesthetic. He has asthma and i am always concerned for anyone being sedated that long let alone my young son. I too pray all will go we'll and he will recover to a decent level of comfort. Again I thank you for your expertise.
Answered by Dr. Nirmala P 1 hour later
Hi and welcome back.

I understand your concern and absolutely agree with you. As adults we can tolerate pain and stress and it is always difficult to see our kids suffer.Children are our life and it always hurts us to see them in such difficult situation.

You have taken a wise decision in opting for surgery. Anybody undergoing surgery are well prepared and will be taken up for surgery only after anesthetic assessment. Well controlled asthmatics tolerate anesthesia better. Reports indicate a minimal 2% incidence of bronchospasm during surgery especially if routine medication is continued.

Sometimes drugs taken for asthma are substituted for better formulations or preparations, (like Salbutamol nebulizer instead of tablet or IV hydrocortisone instead of tab. Prednisolone) before surgery to help the person tolerate the extra stress of surgery.

General anesthesia means "reversible" loss of consciousness. Regional anesthesia is mostly preferred in asthmatics. Drugs like Ketamine are absolutely safe in asthmatics as it relieves bronchospasm. Even many general anesthetics like Halothane are safer when given along with oxygen.

Since there is a wide choice of anesthetics available for asthmatics, there is no need for worry. But keep asthma under control both before and after surgery.

I whole-heartedly wish him a uneventful surgery and speedy recovery.

Good luck!!

P.S: If you have no more queries, please close this discussion and rate my answer.
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