Children Posterior cruciate ligament (PCL) & Lateral ligament reconstruction, Patella surgery

Children Knee joint , Patella X ray  Arthroscope in knee joint  Tibial tunnel under IITV guidance  Post operative children knee joint x ray , Implant  Posterior cruciate ligament (PCL) brace , knee brace  SLR with knee brace (PCL brace)

PCL and Lateral ligament reconstruction surgery with Patella surgery

This 13 years young, active boy was brought to us from Rajasthan for his continues problems of his left knee joint since one year . He sustained a fall in the home and dislocated his kneecap [patella] two times. He was not able to run and always had difficulty in stair climbing as well as in sitting on the ground. Mother being a nurse in the hospital, he underwent many types of conservative management those failed to give him any relief. He was advised surgery for patella when actually he had multiple ligaments injury of his knee joint. Due to this the patella was being overloaded and he was having symptoms of kneecap problems.

He underwent two ligaments reconstruction simultaneously. Posterior cruciate ligament [PCL] reconstruction & lateral ligament [outside ligament of the knee] surgery. His patella was also stabilized with arthroscopic procedure. This surgery was performed under IITV guidance. The knee became absolutely stable after reconstruction.

This is a very rare surgery where 3 pathologies of a knee were addressed at a single stage in a such a young boy who still has lots of growth potential remaining. LIterature search on Pubmed could not find such surgery in this age group. This surgery needed high operative skills, many advanced instruments and surgical experience. In such cases, most of the time orthopaedic surgeons wish to wait till the child is 17 or 18 years old so that the growth is over & deformity as well as shortening can be avoided.

Unfortunately, this boy already had approximately 2 cm wasting of quadriceps (thigh) muscles because of untreated painful knee was not allowing him to do any sports activity or exercises. More waiting without ligaments reconstruction surgery would have done additional damage to the knee. Author’s previous experience in more than 40 cases of knee ligament surgeries in children and adolescents has shown no growth problems after trans-epiphyseal tunnels.

This young man will be under observation till his growth potential is over.

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