r/Sportsinjuriesindia

Posted a clip of a moment from an ACL reconstruction today.
Guide wire comes out. Surgeon steps back. Knee is closed.
But something got left inside that joint, something that’ll hold the new graft in place and then vanish on its own over the next several months.

What do you think it is?
And does the idea of something dissolving inside your knee freak you out or fascinate you?
Genuinely curious what u think when u see this moment.

One of the most important lessons in knee surgery: if the alignment is wrong, your ACL graft will fail.

She came to us with a painful, unstable left knee.
The diagnosis? A combination that’s more common than people realize — genu valgum (knock knee deformity) with a ACL tear.

This put me into a dilemma of what should I do the deformity or the ligament because both are related to each other

The problem with just doing ACL reconstruction In a knock knee, the mechanical axis passes lateral to the knee centre. This means every time the patient walks, runs, or lands from a jump, the forces on that ACL graft are skewed. Studies consistently show that uncorrected valgus malalignment dramatically increases graft failure rates. You’re essentially rebuilding a rope and then hanging it at the wrong angle.

The plan: staged correction
We performed a Distal Femoral Osteotomy (DFO) — a lateral closing wedge — to correct the valgus deformity, fixed with a distal femoral locking plate. Simultaneously, ACL reconstruction was completed. The alignment is now corrected. The graft has a fighting chance.
Key takeaways for anyone reading this:

Alignment always trumps ligament reconstruction. Fix the bone first, or alongside.
Young active patients with valgus + ACL tears are not straightforward ACL cases.
Skipping the osteotomy is a shortcut to revision surgery.

She is now 7 weeks post-op, full weight bearing, and starting rehab. 💪

happy to discuss DFO indications, the combined vs staged approach debate, and rehab timelines.​​​​​​​​​​​​​​​​

Uploading a short intraoperative clip from today’s ACL reconstruction.
What you’re seeing is a bioabsorbable interference screw being driven in to secure the graft inside the tibial tunnel. This is one of those moments that patients never get to see, and have I decided to share so that it fulfil is your thirst of knowledge.
A few things to note.
A] The screw is bioabsorbable, meaning it gradually dissolves and is replaced by bone over 12–18 months

B] Proper screw placement is critical , too proud or too deep and you risk graft impingement or poor fixation strength

C] The tactile feedback as it seats flush is something you learn to trust over hundreds of cases

For those post-op and curious: This tiny screw is doing a lot of the heavy lifting in your early rehab weeks while the graft is still integrating.

Respect the timeline we as surgeons give u ..
Happy to answer questions .