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Anterior Cruciate Ligament (ACL) Reconstruction

The ACL reconstruction is a surgery that is performed to repair a torn ligament in the knee.

The Anterior Cruciate Ligament (ACL) connects the shin bone to the thigh bone and helps to hold the knee joint in place along with 3 other ligaments.  When this ligament is torn due to sporting activities or accidents, it needs to be surgically reconstructed in most cases. If not, it causes a feeling of the knee giving away and can be painful.

Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 3 hrs
Cost Estimate: Cost Estimate: 1800 USD - 3398 USD These are indicative prices in Indian Hospitals

When The Anterior Cruciate Ligament tears, unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.

  • Most injuries are sports related involving a twisting injury to the knee.
  • It can occur with a sudden change of direction, a direct blow e.g., a tackle, landing awkwardly.
  • Often there is a popping sound when the ligament ruptures.
  • Swelling usually occurs within hours.
  • There is often the feeling of the knee popping out of joint.
  • It is rare to be able to continue playing sport with the initial injury.

Once the initial injury settles down the main symptom is instability or giving away of the knee. This usually occurs with running activities but can occur on simple walking or other activities of daily living.

Description of the Surgery

ACL reconstruction is generally performed under general anaesthesia or spinal anaesthesia.

In most cases, ACL reconstruction is performed by knee arthroscopy.  A small cut is made on the knee and a tiny camera is inserted into the knee.  The camera transmits the video of the surgical site to a screen. More such cuts are made around the knee to accommodate the other operating instruments that the surgeon uses.  The surgeon operates on the knee by looking at the transmitted video on a screen.

In this surgery, the torn ligament is typically replaced / reconstructed with another piece of tissue from the knee called “graft”.  When the graft is sourced from the patient, it is called an autograft. Cadaver grafts are also available – these are called allografts.

The torn ligament is first completely removed.  Small tunnel–like spaces are drilled in the shin bone and the thigh bone.  The graft is passed through these two tunnels thus recreating the torn ligament between the two bones.  The graft is held in place with screws, staples or buttons. With time, as healing occurs, the tunnels get filled up with bone.  The screws, staples or buttons will remain permanently in place and need not be removed.

The small cuts made for the arthroscopy are then closed with sutures (stitches) and a dressing is placed on the knee.  Here ends the surgery.

Rehabilitation

Rehabilitation after ACL reconstruction is particularly long, lasting anywhere between 2 to 6 months, depending on the extent & type of injury as well as patient demographics such as age, occupation, etc.  Most patients are discharged within a day after surgery. A knee brace is usually prescribed for 1 to 4 weeks. Crutches will have to be used for moving around during these 1 to 4 weeks. Patients are encouraged to move the knee right after surgery to prevent stiffness.

Painkillers are prescribed to manage pain for a few days.

The most important part of rehabilitation after ACL reconstruction is physiotherapy.  Physiotherapy, under the supervision of a trained therapist, will help the patient to regain a good range of motion as well as strength in the knee joint.  Physiotherapy may be required for as many as 2 to 6 months after surgery.

Most patients return to normal life in about 4 to 6 months’ time.  Return to work will depend on the type of work that the patient does in addition to the extent of injury.  It can range from a few days to a few months.

Risks / Complications

The most common complications of ACL reconstruction are pain in the knee (in about 20% of patients) and incomplete restoration of range of motion of the knee (in less than 5% of patients).

The common risks associated with this procedure, as with any surgery, are infection and bleeding.  Specific risks associated with this procedure include blood clot lodged in the veins of the leg, failure of the ligament to heal and injury to nearby blood vessels.

Outlook

ACL reconstruction, in otherwise healthy patients, is usually an uneventful procedure with reliable outcomes.  While the surgery itself may be successful, it is the 2-6 months’ rehabilitation that actually ensures return to normal quality of life after surgery.

 

Early surgical intervention with an ACL injury can result in bone growth problems in children and damaging scar tissue in adults. This is why those with partial ACL tears are often encouraged to undergo extensive physical therapy to restore their knee function and learn ways to prevent future injuries. However, half of all ACL injuries are called combined injuries, meaning they also result in damage to the meniscus, cartilage, or other ligaments. If you experience this type of damage and are actively involved in sports, you will need an ACL repair surgery to avoid secondary damage to your knee.

During the two weeks leading up to your surgery, you may be asked to stop taking certain medications. This is particularly true with blood thinners and drugs that reduce clotting such as aspirin, ibuprofen, and naproxen. Be sure to tell your surgeon about any and all drugs that you are currently taking during your surgical consultation. Your doctor should also know about any cases of fever, cold, flu or other illnesses that may affect your procedure. Typically, you will be required to avoid eating or drinking anything for six to twelve hours before surgery.

Using grafts and knee arthroscopy, your torn ACL will be replaced within the joint itself. The tissue graft can be taken from another part of your leg, called an autograft, or donated by another patient, called an allograft. Your damaged ACL will be removed and the graft will be installed in its place using the technique preferred by your surgeon. By using an arthroscope, your surgery can be minimally invasive to encourage smaller incisions and shorter recovery times.

Barring complications, most patients can safely return home the day after their surgery. You may be required to wear a knee brace and use crutches for one to four weeks, but you will begin doing exercises to move the operated area immediately after surgery in order to reduce stiffness and scarring. Physical therapy in the months following your surgery are key to regaining motion and strength. Most doctors recommend between four and six months of physical therapy before returning to any strenuous activity or sport. But how soon you can return to work or play will depend entirely on the success of your individual recovery process.

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