ACL Reconstruction Surgery in India

Symptoms of an ACL Tear

The symptoms of an ACL tear can vary depending on the severity of the injury, but common signs include:

• A Popping Sound – Many people report hearing or feeling a “pop” at the moment of injury. This sound usually signals that the ligament has torn.
• Severe Knee Pain – Pain is typically immediate and intense after the injury, especially when trying to bear weight on the affected leg.
• Swelling – Within a few hours of the injury, the knee may swell due to internal bleeding. The swelling can make it difficult to move or bend the knee.
• Loss of Stability – The knee may feel unstable or “give out” when walking or standing, especially when pivoting or turning.
• Limited Range of Motion – After an ACL tear, the knee’s ability to fully extend or flex is often limited due to pain, swelling, or mechanical issues in the joint.

Types of ACL Surgery

There are two main types of ACL surgery based on the type of graft used to replace the torn ligament:

1. Autograft ACL Surgery

In this procedure, a graft is taken from the patient’s own body. Common sources for the graft include:

• Patellar Tendon – A portion of the patellar tendon, located between the kneecap and the shinbone, is often used. This graft is strong and heals well, but can sometimes cause pain at the front of the knee.
• Hamstring Tendon – The hamstring tendon, taken from the back of the thigh, is another common graft option. It generally results in less post-surgical pain compared to the patellar tendon graft.
• Quadriceps Tendon – A less commonly used graft that comes from the quadriceps muscle above the knee. This option may be chosen if the other two tendons are not suitable.

2. Allograft ACL Surgery

This type of surgery involves using a graft from a donor (cadaver tissue). It eliminates the need for harvesting tissue from the patient, reducing surgical time and post-operative pain. However, ACL recovery time may take longer, and there’s a slight risk of the body rejecting the graft.

These types of ACL surgeries are selected based on factors such as the patient’s activity level, age, and preference of the surgeon.

ACL Reconstruction Surgery Procedure - Steps of ACL Reconstruction Surgery

The procedure is typically performed arthroscopically and involves the following steps:

• The patient is given anesthesia, usually general anesthesia, to ensure they are asleep and pain-free during the procedure. The surgeon cleans and sterilizes the knee area to prevent infection.
• The surgeon makes small incisions around the knee to insert an arthroscope, a small camera that allows the surgeon to visualize the inside of the knee joint. This provides a clear view of the torn ACL and other structures inside the knee. The surgeon also checks for other injuries, such as damage to the meniscus or cartilage.
• Once the torn ACL is confirmed, the surgeon removes the damaged ligament using specialized surgical tools. This creates space for the new ligament graft.
• If an autograft is used, the surgeon will harvest the graft from the patellar, hamstring, or quadriceps tendon. In the case of an allograft, the graft will already be prepared from a donor. The graft is trimmed to the correct size for the knee.
• To secure the graft, the surgeon drills small tunnels into the femur (thighbone) and tibia (shinbone). These tunnels allow the graft to be placed in the same position as the original ACL, ensuring proper alignment.
• The prepared graft is threaded through the bone tunnels and positioned in the knee joint. The surgeon carefully pulls the graft into place, ensuring that it mimics the function and positioning of the natural ACL.
• The graft is secured in place using screws, buttons, or other fixation devices that hold it firmly to the bone. Over time, the bone will grow around the graft, permanently securing it in place.
• Once the graft is securely in place, the surgeon closes the small incisions with sutures or surgical staples. The knee is then bandaged, and a brace or dressing may be applied to support the joint during initial recovery.
• After surgery, the patient is moved to a recovery room to wake up from anesthesia. Physical therapy begins soon after surgery to help restore range of motion, strength, and function in the knee. Full ACL recovery can take several months, depending on the individual and the type of graft used.
• This step-by-step process ensures that the ACL is properly reconstructed, allowing patients to gradually return to normal activities and regain knee stability.

How Should A Patient Prepare For ACL Reconstruction Surgery?

Preparing for ACL reconstruction surgery involves several important steps to ensure a smooth procedure and optimal recovery. Here’s a comprehensive guide to help you prepare:

• Before the surgery, you will have a detailed consultation with your orthopedic surgeon. Discuss your symptoms, medical history, and any medications you are taking. Ask questions about the procedure, potential risks, and what to expect during recovery.
• Your surgeon will provide specific instructions regarding medications. You may need to stop taking blood thinners, anti-inflammatory medications, and certain supplements several days before surgery to reduce the risk of bleeding. Consult your surgeon about any medications you should continue or discontinue.
• Organize your post-surgery care in advance. Arrange for someone to drive you home after the procedure, as you may still be under the effects of anesthesia. It’s also helpful to have someone available to assist you for a few days during your initial recovery.
• Follow any dietary guidelines provided by your surgeon. You may be instructed to fast for a certain period before the surgery, especially if general anesthesia is planned. Stay hydrated and maintain a balanced diet in the days leading up to the surgery to promote healing.
• Mental readiness is essential for a successful surgery and recovery. Educate yourself about the procedure, set realistic expectations, and discuss any concerns with your healthcare team. Consider relaxation techniques such as deep breathing or meditation to reduce anxiety.
• Adhere to any specific instructions given by your surgeon, such as avoiding smoking or alcohol in the days leading up to the surgery. These factors can impact healing and recovery.
• On the day of your surgery, wear loose, comfortable clothing and remove any jewelry, makeup, or nail polish. Arrive at the hospital or surgical center as instructed, and follow any additional guidelines provided by the staff.

ACL Surgery Cost

The cost of ACL surgery can vary widely based on several factors. On average, the total cost can range from Rs 2,65,000 to Rs 3,00,000 or more. This range reflects variations in location, facility type, surgeon expertise, and additional expenses related to the procedure.

Factors Affecting ACL Surgery Costs are:

• Geographic Location – The cost of healthcare varies significantly by region and country. Urban centers often have higher costs than rural areas due to higher demand and operational expenses.
• Type of Facility – Costs can differ based on whether the surgery is performed in a hospital or an outpatient surgical center. Hospitals generally charge more due to their comprehensive services and overnight stay facilities.
• Surgeon’s Experience – Highly experienced orthopedic surgeons may charge more for their expertise, which can contribute to the overall cost of the surgery.
• Type of ACL Reconstruction – There are different methods of ACL reconstruction (e.g., autograft vs. allograft). The choice of graft type can impact the overall cost, as some grafts (like cadaver tissue) are more expensive than others.
• Insurance Coverage – The extent of insurance coverage can significantly affect out-of-pocket costs. Some insurance plans may cover a portion of the expenses, while others may have high deductibles or co-pays.
• Pre-operative and Post-operative Care – Costs related to consultations, diagnostic imaging (like MRI), physical therapy sessions, and follow-up visits can add to the total cost of the procedure.
• Medications and Anesthesia – The cost of anesthesia and any medications prescribed before or after surgery (like pain management drugs) should also be factored into the overall expenses.

ACL Surgery Recovery Time

Recovery after ACL surgery typically occurs in phases, each with varying timelines and milestones. 

Immediate Post-Operative Phase (0-2 Weeks)

• Focus – Rest, pain management, and initial healing.
• Activities – Use of crutches is common, with minimal weight-bearing on the leg.
• Goal – Control swelling and begin gentle range-of-motion exercises.

Early Rehabilitation Phase (2-6 Weeks)

• Focus – Begin physical therapy to regain knee movement.
• Activities – Gradually increase weight-bearing as tolerated; start physical therapy sessions.
• Goal – Restore range of motion and reduce swelling.

Strengthening Phase (6-12 Weeks)

• Focus – Strengthening the muscles around the knee.
• Activities – Continue physical therapy with strength training exercises.
• Goal – Improve stability and function of the knee joint.

Advanced Rehabilitation Phase (3-6 Months)

• Focus – Enhance functional capabilities and return to sports-specific activities.
• Activities – Gradual return to normal activities and sports training.
• Goal – Achieve strength and mobility close to pre-injury levels.

Full Recovery Phase (6-12 Months)

• Focus – Complete recovery and return to high-level sports.
• Activities – Full participation in sports and high-impact activities.
• Goal – Full restoration of knee function and strength, allowing a return to pre-injury activities.

Benefits of ACL Reconstruction Surgery

• ACL reconstruction stabilizes the knee, preventing it from giving way during activities.
• The surgery alleviates pain caused by a torn ACL, allowing for improved mobility.
• Patients experience better knee function, enabling them to return to sports and physical activities.
• Repairing the ACL can help protect other knee structures, reducing the risk of additional injuries.
• With restored knee function and reduced pain, individuals can engage in daily activities and sports without limitations.
• Surgeons can tailor the reconstruction technique based on individual needs, optimizing outcomes.
• Advances in surgical techniques have led to quicker recovery times, allowing patients to resume normal activities sooner.
• Successful ACL reconstruction can provide lasting stability and functionality for many years.
• Knowing the knee is stable can boost confidence in performing physical activities and sports.
• The surgery is often accompanied by a structured rehabilitation program that enhances overall knee strength and mobility.

Can ACL Tear Be Treated Without Surgery?

Yes, an ACL tear can sometimes be treated without surgery, particularly for individuals with partial tears or those who are less active. Here are some non-surgical options:

• Physical Therapy – A structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and enhance stability. Therapists often use specific exercises to restore function and prevent further injury.
• Bracing – Using a knee brace can provide support and stability during activity. Braces help limit excessive movement of the knee, reducing the risk of further injury while promoting recovery.
• Activity Modification – Avoiding high-impact activities that strain the knee can help manage symptoms and prevent further damage. Low-impact exercises, such as swimming or cycling, may be recommended to maintain fitness without stressing the knee.
• Rest and Ice – Taking time off from activities that exacerbate the pain and applying ice to the affected area can help reduce swelling and pain, promoting healing.
• Anti-inflammatory Medications – Over-the-counter medications like ibuprofen or naproxen can help manage pain and reduce inflammation associated with an ACL injury.

While these non-surgical options can be effective in managing symptoms and aiding recovery, they are generally not as beneficial as surgery, especially for those with complete tears or active individuals who wish to return to high-level sports. Surgical intervention often provides more reliable stability and a better long-term outcome, allowing individuals to return to their previous level of activity with confidence.

Risks and complications of ACL Reconstruction Surgery

• Excessive bleeding during or after the surgery can occur, which may necessitate a blood transfusion or further medical intervention.
• Formation of blood clots in the legs (deep vein thrombosis) can occur, posing a serious health risk and requiring preventive measures.
• Surgery may inadvertently cause damage to nearby nerves, leading to numbness, tingling, or weakness in the knee or leg.
• Some patients may experience stiffness or a decreased range of motion in the knee, which can affect recovery and function.
• The reconstructed ACL can re-tear, particularly if the knee is subjected to high-impact activities too soon after surgery.
• Some individuals may experience ongoing pain in the knee even after successful surgery.
• In rare cases, the body may reject the graft used for reconstruction, requiring further surgical intervention.
• If the surgery does not succeed, patients may continue to experience instability in the knee, which can affect mobility and confidence.
• Concerns about re-injury or ongoing pain can lead to anxiety or depression, impacting recovery and overall well-being.

Understanding these risks is crucial for patients to make informed decisions about undergoing ACL reconstruction surgery. Proper pre-operative assessment and post-operative care can help mitigate some of these complications.