ACL Reconstruction Surgery in Delhi, India

ACL reconstruction surgery is a medical procedure designed to reconstruct a torn anterior cruciate ligament (ACL) in the knee. This surgical intervention is commonly performed to restore stability and function to the knee joint following an ACL injury. During the procedure, the damaged ligament is replaced with a graft, often taken from the patient's own body (autograft) or from a donor (allograft).

ACL reconstruction surgery can be categorised into three main types - Autograft, Allograft, and Synthetic Graft.

1. Autograft

Autografts involve using the patient's own tissue for ACL reconstruction. Common autograft options include:

• Patellar Tendon Autograft (Bone-Patellar Tendon-Bone - BPTB): Involves using a strip of the patellar tendon along with a small piece of bone from the patella and tibia.
• Hamstring Tendon Autograft: Uses two of the hamstring tendons (gracilis and semitendinosus) harvested from the back of the thigh.
• Quadriceps Tendon Autograft: Uses the central portion of the quadriceps tendon, including a bone block from the patella.

2. Allograft

Allografts utilise tissue from a cadaver donor for ACL reconstruction. Common allograft options include:

• Patellar Tendon Allograft: Involves using the patellar tendon from a donor.
• Hamstring Tendon Allograft: Uses hamstring tendons from a cadaver.
• Achilles Tendon Allograft: Utilises the Achilles tendon from a donor.

3. Synthetic Graft

Synthetic grafts are less common and involve using materials other than biological tissue. While synthetic grafts are still in the early stages of development and research, potential options include:

• Polyester Graft: Made of synthetic polyester fibres.
• Carbon Fibre Graft: Utilises carbon fibre materials.

ACL injury is common among athletes and individuals involved in activities that involve sudden stops, changes in direction, or pivoting movements. Here are some key reasons why ACL reconstruction or repair surgery may be performed:

• Restore Knee Stability: The ACL plays a crucial role in maintaining stability and preventing excessive forward movement of the tibia (shinbone) in relation to the femur (thighbone). When the ACL is torn, the knee can become unstable, leading to feelings of "giving way" or instability during physical activities. ACL repair aims to restore knee stability and improve functional outcomes.
• Relieve Symptoms: A torn ACL can cause pain, swelling, and difficulty in bearing weight on the affected knee. ACL repair helps alleviate these symptoms, allowing individuals to regain pain-free movement and return to their normal activities.
• Facilitate Rehabilitation: ACL repair is often performed to facilitate effective rehabilitation and the restoration of normal knee function. By surgically repairing the torn ACL, the healing process can be enhanced, providing a solid foundation for rehabilitation exercises and reducing the risk of further damage.
• Prevent Secondary Injuries: A torn ACL can increase the risk of developing secondary injuries, such as meniscus tears or cartilage damage, due to the instability and abnormal movement patterns of the knee. By repairing the ACL, the risk of these additional injuries can be reduced, promoting long-term joint health.
• Maintain Knee Joint Health: The ACL is crucial for maintaining the overall health and integrity of the knee joint. Without a functional ACL, the joint may experience abnormal forces and stress, leading to accelerated wear and tear, joint degeneration, and an increased likelihood of developing osteoarthritis in the future. ACL repair aims to preserve the long-term health of the knee joint.

• The doctor will take the patient’s personal and family medical history.
• The patient will have to undergo lab, diagnostic and imaging tests to ensure they are fit for the procedure.
• The doctor may start or stop certain medications before the procedure; they will ask what the patient is currently using as well.
• It is advisable that individuals quit smoking a few weeks before the procedure since it can interfere with healing.
• Exercising regularly before the procedure can help with post-operative healing.

• Anaesthesia is administered.
• A tendon is taken from the body or a donor.
• The tendon is drilled into the thigh bone and shinbone, and secured with bolts or screws.
• The new tendon will act as a foundation for the ligament to grow on.

• Prolonged, persistent pain.
• Poor graft healing.
• Graft failure.
• Blood clots.
• Anaesthesia-related complications.
• Blood vessel damage.

• The patient can go home walking the next day after the surgery.
• Patient can perform his day to day activities right from the next day of surgery. Patient is not allowed to perform any strenuous activity.
• The doctor may put a brace or suggest using a stick for a few days after surgery.
• Generally it takes 6 weeks to walk without any braces. Brisk walking can be started after this period. But any contact sports or dancing is allowed only after 9 months of surgery.
• Patients are encouraged to take physical therapy to help strengthen their muscles around the knee.
• Pain relief medications are provided in the initial few days of surgery. Most of the patients don't need any painkillers after 7 days of surgery.
• Regular follow-ups can help doctors monitor the recovery.

Q1. Can an ACL tear heal without surgery?

An ACL tear can potentially heal without surgery, but it depends on the severity of the tear, type of tear and the individual's activity level. Some people with partial ACL tears or who are not very active may be able to manage their symptoms and regain some stability through physical therapy and rehabilitation. However, for most young people with a complete tear or who are involved in sports or an active lifestyle, surgery is typically recommended to reconstruct the torn ligament and restore stability to the knee joint.

Q2. Is ACL surgery painful?

ACL surgery is a minimally invasive surgery performed using an arthroscope. There is minimal pain after surgery which can be very well managed by usual doses of painkiller, ice pack and limb elevation. As the rehabilitation process progresses, the need for painkillers reduces.

Q3. Can the ACL heal on its own?

In general, the ACL cannot heal on its own once it has been torn. Unlike some other parts of the body, such as bone or muscle tissue, the ACL does not have a good blood supply, which makes it difficult for the body to repair itself.

Q4. Is ACL surgery a successful procedure?

ACL (anterior cruciate ligament) surgery is generally considered a very successful procedure. Success rates vary depending on several factors, such as the surgeon's experience, the severity of the injury, and the rehabilitation process.

Q5. What is the cost of ACL surgery?

The cost of ACL surgery can vary widely depending on factors such as geographic location, surgeon fees, anaesthesia fees, hospital fees, and rehabilitation costs.

Q6. How many hours does ACL surgery take?

The length of an ACL surgery is generally between 30-45 mins. It's important to note that the length of the surgery is not necessarily an indication of its success or effectiveness.

Q7. When Is an ACL Reconstruction Surgery Performed?

Anterior Cruciate Ligament (ACL) reconstruction surgery is typically performed when there is a significant injury to the ACL, which is a cruciate ligament in the knee. The ACL is responsible for providing stability to the knee joint by preventing excessive forward movement and rotation of the shin bone (tibia) relative to the thigh bone (femur).

Q8. What are the common scenarios in which ACL injuries occur?

ACL injuries often occur during sports activities that involve sudden stops, changes in direction, or direct blows to the knee. Common scenarios include:

• Sports Injuries: ACL tears frequently occur in sports such as soccer, basketball, football, skiing, and other activities that involve rapid changes in direction or sudden stops.
• Trauma: Accidents, falls, or direct blows to the knee can lead to ACL injuries.
• Repetitive Stress: Over time, repetitive stress on the knee joint, such as in certain types of occupational activities or exercises, can contribute to ACL damage.
• Complete ACL Tears: In many cases, ACL injuries involve a complete tear of the ligament, making surgical intervention more likely.

Q9. What are the key factors that influence the decision to perform ACL reconstruction surgery?

The decision to perform ACL reconstruction surgery is often influenced by several factors, including:

• Severity of the Injury: Complete tears or significant damage to the ACL may necessitate surgery to restore stability to the knee.
• Age and Activity Level: Young, active individuals who participate in sports or activities that require knee stability may be more likely to undergo surgery to return to their previous level of function.
• Presence of Other Injuries: If there are additional injuries to the knee, such as damage to meniscus or other ligaments, they may be addressed during the surgical procedure.
• Patient Preferences: Some individuals may opt for non-surgical management, especially if they have a less active lifestyle or if the injury is partial and the knee remains stable.

Q10. When can I start walking after ACL repair surgery?

Walking typically begins soon after surgery, aided by crutches. Full weight-bearing may take a few weeks, depending on individual recovery.

Q11. Can I return to sports after ACL repair surgery?

Yes, but the timing varies. Return to sports is usually gradual and guided by the surgeon and physical therapist, often several months post-surgery.

Q12. Do I have to wear a brace post ACL reconstruction surgery?

A knee brace may be prescribed initially for support, but it is often gradually phased out during the rehabilitation process.

Q13. How much time off work will the ACL reconstruction surgery require?

The time off work depends on the type of job and the individual's recovery. It may range from a few days to several weeks.

Q14. What if I don’t undergo ACL repair surgery?

Without surgery, some individuals may experience ongoing instability, a higher risk of meniscus injury and further knee damage, and limitations in activities. Non-surgical options and lifestyle modifications may be considered, but the decision depends on individual circumstances.

Q15. Who are the specialised medical professionals trained to perform ACL reconstruction surgery?

Orthopaedic surgeons or ACL surgeons, particularly those specialising in sports medicine, are the specialised medical professionals trained to perform ACL reconstruction surgery.

Q16. How is ACL reconstruction surgery different from joint pain treatment, knee pain treatment, and osteoarthritis treatment?

The terms "joint pain treatment", "knee pain treatment", and "osteoarthritis treatment" can be related and may involve a variety of medical professionals, including general practitioners, rheumatologists, and orthopaedic specialists. These treatments may include medications, physical therapy, and lifestyle modifications.

On the other hand, "ACL reconstruction surgery" is a specific surgical procedure performed by orthopaedic surgeons, particularly those specialised in sports medicine, to address a torn anterior cruciate ligament (ACL) in the knee. While joint and knee pain treatments may involve non-surgical approaches, ACL reconstruction surgery is a surgical intervention specifically for the knee ligament.

Reviewed by Dr. Ramneek Mahajan, Senior Director (Orthopaedics) & Head Joint Reconstruction (Hip & Knee) Unit, Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury, Robotic Surgery on 30 Jan 2024.