ACL Surgery
in Hyderabad, India
PACE Hospitals is recognized as one of the Best hospitals for ACL reconstruction surgery in Hyderabad, Telangana, India. With a team of top orthopedic doctors and orthopedic surgeons, we provide advanced care through a patient-centered approach. Our experts specialize in minimally invasive arthroscopic techniques to ensure faster recovery, restored knee stability, and improved mobility.
ACL reconstruction surgery is a highly effective procedure for treating torn anterior cruciate ligaments, often caused by sports injuries or trauma. At PACE Hospitals, we offer cutting-edge treatment options, using the latest medical advancements to deliver safe and successful outcomes. With transparent ACL surgery costs and world-class facilities, we are a trusted destination for knee ligament repair in Hyderabad.
Book an appointment for
ACL Surgery
ACL Reconstruction Surgery appointment
Why Choose PACE Hospitals for ACL Reconstruction Surgery?
What is ACL Reconstruction Surgery?
ACL reconstruction is a surgical procedure that repairs the ligament in the centre of the knee. The anterior cruciate ligament (ACL) connects the tibia (shin-bone) to the femur (thigh bone). A tear in this ligament may lead the knee to give way during physical activity, most commonly during side-step or crossover movements.
An orthopaedic surgeon will make one or more incisions around the knee. Most surgeons perform the procedure using arthroscopy (keyhole surgery), which involves using a camera to examine the inside of the knee. The surgeon will then replace the ACL with appropriate tissue (a graft) from another part of the body or donor tissue.
ACL Reconstruction Graft Types
Each type of graft has advantages and disadvantages; therefore, the choice is determined by patient-specific characteristics such as age, activity level, and personal preferences. Below are the various types of ACL reconstruction grafts:
- Autografts
- Bone-patellar tendon-bone (BPTB) autograft
- Hamstring tendon autograft
- Quadriceps tendon autograft
- Allografts
- Cadaveric tissue
- Synthetic grafts
- Biodegradable synthetic grafts
- Permanent synthetic prostheses
Autografts
- Bone-patellar tendon-bone (BPTB) autograft: The middle third of the patellar tendon and bone plugs from the patella and tibia are taken for this graft. It is frequently regarded as the gold standard because of its strong fixation and great clinical outcomes; however, it may cause anterior knee pain and stiffness after surgery.
- Hamstring tendon autograft: This technique involves tendons from the hamstring muscles, usually the semitendinosus and occasionally the gracilis. It has shown less postoperative pain compared to BPTB grafts and has a lower risk of donor-site problems, but there may be a slightly higher risk of graft failure.
- Quadriceps tendon autograft: This technique employs a portion of the quadriceps tendon, providing good strength and stability while possibly decreasing donor-site morbidity. However, it may have a higher risk of graft rupture compared to other alternatives.
Allografts
- Cadaveric tissue: Allografts use tissue from a deceased donor, such as the patellar, hamstring, or Achilles tendon. They reduce donor-site morbidity, but may have a greater chance of infection and graft failure than autografts.
Synthetic grafts
- Biodegradable synthetic grafts: These are manufactured with materials that gradually degrade over time. They aim to give temporary support while enabling natural tissue repair.
- Permanent synthetic prostheses: Gore-Tex and Dacron grafts are two examples of long-lasting materials that may pose risks such as breakage or chronic effusion. Their use remains controversial because of previous complications.
Arthroscopic ACL Reconstruction Indications
Restoring knee stability and functionality is typically achieved through anterior cruciate ligament (ACL) reconstruction, particularly when conservative treatments are ineffective. Below are some of the indications for ACL reconstruction surgery:
- Recurrent knee instability: Continuous episodes of the knee "giving way" during sports or daily tasks indicate functional instability, which frequently requires surgery.
- High-grade rotational instability: ACL reconstruction is highly recommended for patients with a positive pivot shift test (grade 2 or 3), which indicates significant rotational instability in the knee.
- Chronic ACL injury: Reconstruction is recommended for chronic ACL tears with related instability and functional limitations, especially when conservative measures are unsuccessful.
- Young age and high activity levels: ACL reconstruction is a good option for younger patients (less than 25 years old) who are more active because they are more likely to sustain another injury and experience long-term problems.
- ACL revision surgery: Surgical correction may be beneficial for patients who need revision because of failed primary ACL reconstruction or recurrent injuries to restore stability and prevent additional damage.
- Segond fracture: A Segond fracture, which is an avulsion fracture of the lateral tibial plateau, is a clear sign of an ACL tear and may require surgery.
- Associated meniscal injuries: ACL reconstruction is frequently necessary for concurrent meniscal tears that need to be repaired or excised in order to stabilise the knee and safeguard the repaired meniscus.
- Radiographic findings: Certain radiographic indicators, like lateral coronal plane laxity or lateral femoral notch depression, may suggest surgery is necessary to treat underlying instability.
- Generalized ligamentous laxity: Patients who have significant knee hyperextension (>10°) or generalized ligamentous laxity (e.g., Beighton score >4) are more likely to experience instability and may need surgery.
- Prevention of secondary injuries: ACL-deficient knees are more likely to develop secondary meniscal or cartilage injuries over time, so surgery is frequently advised to reduce this risk.
- Participation in high-risk sports: Surgery is usually advised for people who play sports that require pivoting movements (such as basketball or soccer) or high-level athletic activities that put the knee under rotational stress.
ACL Reconstruction Contraindications
Absolute or relative contraindications for ACL reconstruction surgery are important factors that influence patients' and doctors' decision-making. Below are the contraindications to ACL reconstruction surgery:
Absolute Contraindications
- Active infection: This is a significant contraindication due to the risk of infection spreading during surgery.
- Severe comorbidities: Conditions like severe cardiovascular disease or uncontrolled diabetes can make surgery unsafe for the patient.
- Poor tissue quality: Some procedures, such as primary repair, are absolutely contraindicated in tissue that cannot tolerate sutures or grafting.
- Tears with a distal remnant too short for reinsertion: Primary repair may not be possible if the distal remnant of the ACL is too small to be inserted again.
- Re-rupture of a repaired ligament: Primary repair methods are typically not appropriate for an ACL that has been repaired but has re-ruptured.
Relative contraindications
- Open physes: To prevent growth plate damage, patients with open growth plates may benefit from non-operative treatment at first. However, after the growth plates close, surgical options may be taken into consideration if instability continues.
- Narrow or shallow notch: Graft impingement can result from a tiny notch, which presents technical difficulties for double-bundle reconstruction. In these situations, single-bundle techniques may perform better.
- Severe bone bruising: Delaying surgery to allow for healing and lower the chance of complications during tunnel drilling may be necessary for this condition.
- Low activity levels: Patients with low activity demands may choose non-operative treatment if there is no severe instability.
- Severe arthritic changes: Since surgery may exacerbate advanced
arthritis, non-operative management or alternative therapies may be taken into consideration.
Benefits of ACL Reconstruction Surgery
ACL reconstruction is one of the effective treatment options required to restore knee function and stability, as ACL injuries are common among athletes and active people. Below are the benefits of ACL reconstruction surgery:
- Knee stability: Stability of the knee is restored by ACL reconstruction, which is essential for avoiding additional injuries and ensuring joint integrity.
- Permanent relief from pain: ACL reconstruction surgery reduces inflammation and eliminates pain from an ACL tear.
- Return to pre-injury activities: Following a successful ACL reconstruction, patients can frequently get back to their pre-injury level of activity, including sports.
- Fast recovery: Usually done arthroscopically, ACL reconstruction is less invasive, resulting in fewer problems and quicker recovery.
- Prevention of further knee damage: It lowers the chance of osteoarthritis and early degeneration by preventing any further damage to other knee components like the meniscus and articular cartilage.
- Minimally invasive procedure: These techniques shorten recovery times and postoperative pain, which lowers hospital stays and expenses.
- Early mobility: Early in their rehabilitation, frequently in the initial weeks following surgery, patients can attain good knee mobility.
- Good long-term results: According to studies, ACL reconstruction improves joint stability and symptoms over the long run.
- Reduced societal costs: As ACL reconstruction surgery improves overall quality of life and minimizes work-related disabilities, it lowers societal costs.
ACL Reconstruction Surgery Steps
Arthroscopic ACL reconstruction steps include the following:
Before ACL reconstruction surgery
- In addition to a thorough medical history, the orthopedician usually performs a complete physical examination to ensure patients' good health before going through the surgical procedure, which may include blood tests or additional diagnostic tests.
- Patients need to inform the doctor if they are sensitive to or allergic to any medications, tape, latex, or anaesthetic agents (local and general).
- Patients need to inform the doctor about every medication (prescription and over-the-counter) and herbal supplements they are taking.
- Patients must inform their doctor if they have a history of bleeding disorders or are using any anticoagulant (blood-thinning) medications, aspirin, or other blood-clotting inhibitors. Certain medications may be required to be discontinued prior to the surgery.
- Patients who consume alcohol and smoke should aim to stop or reduce their consumption of alcohol and their smoking habits.
- Patients who are pregnant or suspect they are pregnant need to inform their doctor.
- The doctor will explain the procedure clearly to the patient and allow them to ask any questions they may have.
- Patients will need to sign a consent form authorizing the doctors to perform the surgery. Patients should carefully read the form, if there are any questions, they can ask the doctors.
- Patients are informed not to drink or eat anything from the night before their procedure.
- Patients need to look for and arrange for someone to assist them around the house for a week or two once they are discharged from the hospital.
During ACL reconstruction surgery
- The orthopaedic surgeon makes minor cuts around the knee joint to create the portals of entry for the arthroscope camera and surgical tools.
- After inserting the arthroscope into the knee, saline solution is administered to increase the area surrounding the joint. This creates space for surgical instruments, such as the arthroscopic camera, which allows the surgeon to see inside the knee joint by sending video to a monitor.
- The surgeon then assesses the articular cartilage and the left and right meniscus, which are structures surrounding the torn ACL. The surgeon repairs any lesions in either of these soft tissues.
- If a donor allograft is not used, the graft will then be harvested. A portion of the tendon from another area of the patient's body is cut to create a graft. The patient's iliotibial band, hamstring tendons, or kneecap tendons (quadriceps or patellar tendons) may be used as grafts.
- The graft will eventually become a part of the bone.
After ACL reconstruction surgery
- On the day of the procedure, the majority of patients are able to return home. During the first one to six weeks, patients may require the use of a knee brace.
- Crutches may also be necessary for one to six weeks. The type of surgery patients had and the extent of the reconstruction will determine how long it's necessary to use a brace and crutches.
- After surgery, most patients can move their knees. Stiffness may be avoided in this way. Patients may require medication to alleviate their pain.
- Many people can regain their knee strength and range of motion with physical therapy. The duration of therapy can range from four to six months.
- The type of work patients performs will determine when they return to work. It may last a few days or several months. Usually, it takes four to six months to resume sports and activities fully. Football, basketball, and soccer are examples of sports that require rapid direction changes and may take up to nine to twelve months to recover from.
ACL Reconstruction Complications
Although ACL reconstruction surgery is usually successful, there are a number of possible complications. Depending on their nature and timing, these ACL reconstruction side effects can be divided into various types. Below are some of the ACL reconstruction surgery complications:
Intraoperative complications
- Nerve injury: Numbness and tingling on the inside of the knee may result from unintentional damage to the saphenous nerve.
- Hamstring graft complications: A small graft or weakened hamstring muscle can result from improper harvesting, which can cause weakness in knee flexion.
- Kneecap (Patella) fracture: This fracture may arise as a result of inaccurate bone cuts made during surgery to harvest a bone-patellar-tendon-bone (BPTB) graft.
- Vascular and nerve damage: ACL reconstruction has a risk of damaging major blood vessels and nerves behind the knee, potentially resulting in severe consequences of paralysis or amputation.
Postoperative complications
- Infection: Pain, swelling, redness, and elevated body temperature are symptoms of infection, which indicate the need for antibiotics and sometimes graft removal.
- Stiffness: It is a common complication that results in an incomplete range of motion and is frequently brought on by poor surgical technique or inadequate rehabilitation.
- Anterior knee pain: Patellar tendon grafts are more common at first, but usually go away over time.
- Septic arthritis: It is an infection in the joint, which happens in roughly 0.5 percent of cases.
- Stress fractures: Bone tunnel placement makes it more prevalent on the femoral side.
Long-term complications
- Contralateral ACL ruptures: Increased frequency in patients who had ACL reconstruction, particularly when patellar tendon grafts were used.
- Secondary meniscal lesions: It occurs in roughly 7% of patients, possibly as a result of changed knee mechanics.
ACL Reconstruction Recovery
ACL reconstruction surgery recovery time normally lasts 9 to 12 months, with a focus on range of motion, strengthening, and functional exercises. Most patients achieve normal knee extension within a week and normal flexion three months after surgery. Returning to sports usually takes about 6 months, with a high success rate for individuals who engage in jumping and pivoting activities. Various rehabilitative techniques can improve surgery results and return to sports rates.
ACL Reconstruction Physiotherapy Protocol
The rehabilitation protocol for ACL reconstruction is organized into distinct phases to facilitate the recovery process, such as:
- Phase I (0–2 weeks post-op): Focus on graft protection, swelling reduction, pain management, and restoring knee extension and patellar mobility. Key exercises include quad sets, straight leg raises (if no extension lag), and patellar mobilizations.
- Phase II (3–5 weeks): Aim to maintain full extension, restore full flexion, and normalize gait. Introduce stationary biking, gentle muscle stretching, and strengthening exercises like hamstring curls, step-ups, and partial squats.
- Phase III (6–8 weeks): Continue strength training, incorporate balance and proprioception exercises, and begin more functional movements as tolerated.
- Phase IV (9–12 weeks): Advance to sport-specific drills, plyometrics, and agility exercises, ensuring proper form and control.
- Phase V (3–6 months and beyond): Gradually return to full sports participation, contingent upon passing functional tests and receiving medical clearance.
Progression through each phase is both time-based and criterion-based, emphasizing individualized care tailored to the patient's recovery status.
Questions that the patients can ask the healthcare team about ACL reconstruction surgery?
- When can I go home?
- When do I need to see my doctor again?
- What is the expected recovery time?
- What problems can occur after ACL reconstruction surgery?
- Are there any specific exercises I should avoid while recovering?
- What precautions should I take?
- What kind of pain can I expect?
- When can I go back to my regular activities?
- Will I require physical therapy after surgery, and for how long?
- How long will my recovery take, and what kind of assistance will I require throughout that time?
- Do I need any further treatment?
Difference Between ACL Repair and Reconstruction
ACL repair vs reconstruction
There are two main surgical methods for treating anterior cruciate ligament (ACL) injuries: ACL reconstruction and repair. Reconstruction uses a graft in place of the original ligament, whereas ACL repair reattaches it. Below are some of the parameters that help in differentiating ACL repair and ACL reconstruction:
| Parameters | ACL Repair | ACL Reconstruction |
|---|---|---|
| Definition | ACL repair involves stitching the torn ligament back together, | Using an autograft or allograft to replace the torn ligament. |
| Indications | It is appropriate for certain kinds of tears, especially those that occur close to the bone attachment. | It is usually for patients who are active and have complete tears. |
| Surgical technique | It preserves the initial ligament structure and is less invasive. | It involves creating a tunnel in the bone and harvesting grafts. |
| Recovery time | Patients may resume activities sooner due to a generally quicker recovery. | Longer recovery time: months of rehabilitation are frequently needed. |
| Complications | Possibly fewer graft-related complications. | Graft site issues and altered proprioception are among the risks. |
Single vs Double Bundle ACL Reconstruction
Single-bundle ACL reconstruction normally replaces only one bundle of the ACL, but double-bundle repair restores both the anteromedial and posterolateral bundles, potentially improving knee stability. However, double-bundle reconstruction is more technically challenging and invasive. Studies have found inconsistent findings, with some indicating equivalent outcomes between the two approaches, while others imply that double-bundling may reduce graft failures and enhance stability
Knee Replacement vs ACL Reconstruction
Knee replacement Surgery and ACL reconstruction surgery are separate surgical treatments that address various knee problems. ACL repair replaces a damaged ACL with a graft, restoring knee stability and allowing for the restoration of high-impact activities. Knee replacement includes replacing the knee joint with prosthetic components, generally for severe osteoarthritis, and may have greater complication rates if performed after ACL reconstruction.
ACL Surgery Cost in Hyderabad, India
ACL Reconstruction surgery cost in Hyderabad, India typically ranges between ₹95,000 and ₹1,45,000 (US$1130 to US$1725). The final cost of ACL surgery may vary depending on various factors such as the extent of ligament damage, patient’s age, type of graft and surgical approach, diagnostic tests, hospital stay, rehabilitation, post-surgery care, physiotherapy requirements and whether the procedure is covered under insurance or corporate health plans.
Frequently Asked Questions (FAQs) on ACL Surgery
Can a reconstructed ACL tear again?
Yes, an ACL reconstruction may tear again. Age, activity level, and the type of graft all affect the risk of graft rupture. Younger patients are more likely to sustain reinjury, and allografts carry a higher risk of retear compared to bone-patellar tendon-bone autografts.
How long does ACL reconstruction take to recover?
It usually takes nine to twelve months to recover from an ACL reconstruction before patients can resume a full range of activities or sports. Within the first 12 weeks, the first phase of rapid functional recovery takes place; most patients stop using crutches by 15 days and start driving again by 11 days. There are multiple stages to complete rehabilitation, which conclude with a return to activity about six to nine months after surgery.
What is the success rate of ACL reconstruction surgery?
Usually, ACL reconstruction surgery has a high success rate; depending on parameters like graft type and rehabilitation adherence, 75% to 97% of patients report satisfactory results. About 94% of cases result in long-term stability, and the majority of patients resume their pre-injury level of activity. Nevertheless, a significant minority might need revision surgery or suffer graft failure.
Is life normal after ACL surgery?
Following ACL surgery, most patients report improved knee stability and decreased pain, which enables them to resume their pre-injury activities and lifestyle. After surgery, quality of life usually reaches its pre-injury level within six months. However, osteoarthritis and other chronic knee conditions can affect some people's quality of life.
What are the risks associated with ACL reconstruction surgery?
Infections, pulmonary embolism, deep vein thrombosis, and problems such as tunnel malposition, graft failure, and arthrofibrosis are all potential risks of ACL reconstruction surgery. The overall risk of major complications is minimal, but specific circumstances can raise the risk. Common problems include knee stiffness and venous thromboembolic events.
Is ACL reconstruction a major surgery?
Yes, ACL reconstruction, which usually involves a graft to replace the torn ligament, is regarded as a major surgery. Although recovery requires extensive rehabilitation, the procedure typically takes less than two hours. Even though it's an outpatient procedure, there are risks like graft failure and chronic issues like osteoarthritis.
Which graft is better for ACL reconstruction?
Numerous factors, such as surgeon preference and patient demographics, affect the graft selection for ACL reconstruction. Though bone-patellar-tendon-bone (BPTB) grafts are frequently chosen for younger patients because of their lower graft failure rates, hamstring tendon autografts are widely used throughout the world. Every type of graft has distinct benefits and drawbacks, so there is no one "best" graft.
How long does ACL reconstruction take?
Depending on the technique and any additional procedures needed, ACL reconstruction surgery usually takes one to three hours to complete. Since it is frequently done as a day surgery, patients can go home on that same day. If more injuries are found during the procedure, the time may change.
When to start open chain exercises after ACL reconstruction?
After ACL reconstruction, open-chain exercises can usually be initiated six weeks after surgery under careful supervision. To reduce stress on the graft, the exercises should be performed within a restricted range of motion (45 to 90 degrees). In order to increase quadriceps strength without affecting graft integrity, early introduction with light loads is also advised. After around 12 weeks, a full range of motion exercises can be added.
What are the do’s and don'ts after ACL reconstruction?
Dos After ACL Reconstruction:
- As directed by the orthopedician, a patient needs to use crutches and a knee brace.
- Patients should adhere to a structured rehabilitation program that emphasizes strength and range-of-motion exercises.
- They need to check for complications like graft failure and infection.
Don't After ACL Reconstruction:
- Patients need to avoid strenuous physical activity in the early stages of their recovery.
- To avoid graft stress, the patient should stay away from activities that are not included in the ACL reconstruction rehabilitation protocol.
How to know if ACL reconstruction failed?
Symptoms of ACL reconstruction failure include pain, stiffness, and instability; these are frequently accompanied by a positive Lachman or pivot shift test. Although MRI has limitations in detecting graft insufficiency, stress radiographs and MRI can be used to confirm graft rupture or insufficiency.
Is ACL reconstruction painful?
Usually, ACL reconstruction causes pain, particularly in the initial days following surgery. Pain management is necessary for a few days because pain levels can range from 6 to 7 out of 10. Pain levels can vary depending on the type of graft used; hamstring tendon grafts typically cause less pain than bone-patellar tendon-bone (BPTB) grafts.
Can I drive two two-wheelers after ACL reconstruction surgery?
Driving a two-wheeler after ACL reconstruction is usually not advised until patients have sufficiently recovered knee strength, range of motion, and stability. After surgery, patients are usually advised to refrain from driving for at least 4 to 6 weeks. Because two-wheelers require balance and fast reflexes, they may present additional risks. It's important to discuss this with the doctor before starting to drive again.
Can I put weight after ACL reconstruction?
Following ACL reconstruction, weight-bearing is typically permitted as tolerated, frequently with the initial knee support of crutches for the knee. Immediate weight-bearing has been demonstrated to improve anterior knee pain and quadriceps activity without affecting the integrity of the graft. Nevertheless, depending on specfic surgical recommendations and the existence of concurrent injuries, the degree of weight-bearing may differ.
Can I delay my ACL surgery?
According to some research, delaying ACL reconstruction surgery for six months or more following an injury may raise the chance of developing a meniscus tear or cartilage damage and the likelihood of requiring ACL revision surgery in the future.
