ACL surgery or ACL Reconstruction surgery (also called as Knee ligament surgery) is the surgical repair of an injured ACL or ACL tear using a graft tissue. Anterior cruciate ligament (ACL) is one of the four ligaments that keep the knee joint stable. The others are posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament. ACL connects the femur (or the thigh bone) with tibia (the shin bone) and runs diagonally in the middle of the knee. This is a very important ligament that prevents the tibia from moving forward (anterior movement) off the femur. 

The ACL reconstruction surgery may be done under general or epidural anaesthesia. The surgeon makes two or three small incisions in the sides of the knees. An arthroscope is inserted through one of the incisions to view the joints. The other incisions carry surgical drills, suction tubes etc. Once the arthroscope is set, the surgeon drills small holes in the end of the tibia and femur bones to make small tunnels. These tunnels serve as anchors to the graft. The surgeon then fixes the graft tissue into these tunnels which are then fastened using screw or staples. The incision is then sutured and the patient is shifted to the recovery room. The whole procedure typically lasts around one hour. 

ACL surgery will cost between 4,200 to 5,500 USD in India. This cost would cover the following

·      Room rates

·      Cost of surgery

·      Surgeon’s fees

·      Basic investigations

·      Consultations by doctor during the hospitalisation time

·      Pharmacy and Consumables during the surgery 

The cost would vary based on the type of hospital, type of room chosen (private rooms will be expensive compared to shared rooms), experience of the surgeon etc. You will be required to stay in the hospital for 3 days including the day of surgery. If you are travelling to India for ACL surgery, you should plan for 15 days total which includes time for consultation and tests before the surgery and also post-surgery follow-up checks with the doctor. Hotel accommodation costs would start from 15 USD per day. After the surgery, doctor would advise physical therapy sessions with a physiotherapist for which the charges would be around 10-12 USD per session. Thus, total expenses for ACL surgery in India would be around 4,700 to 6,000 USD excluding travel costs. This cost is still much lower compared to USA (starting from 22,000 USD), Australia (14,000 -16,000 USD) and countries in Europe. This cost advantage plus the high experience level of surgeons make India a much sought after destination for ACL surgery.

ACL injury is the most common form of sports injuries accounting for more than 80% of sports injuries. This more common among amateur sportspersons than the general population. The sports activities that create maximum damage to ACL are football, rugby, basketball, cricket, tennis, volleyball etc. The main reasons for ACL injury are:

·     Sudden slowing down and change of direction or cutting. E.g.- Football, Rugby, Cricket

·     Pivoting on a firm foot. E.g.- Basketball

·     Landing from a jump incorrectly or landing on a single leg. E.g.- Volleyball, Basketball

·     Stopping abruptly. E.g.- Tennis

·     Direct blow to the knee or the outside of the leg. E.g.- Football, Volleyball, Rugby, Basketball.

Though commonly regarded as a sports injury, ACL tear can also occur due to trauma to the knees, sudden change in posture, falls and a variety of other reasons. Interestingly, females are more prone to ACL injury than males. This could be due to Also, persons in the age group of 15 to 45 years are more affected, maybe due to their more active lifestyle.

ACL injury is of sudden onset, the symptoms also appear simultaneously. The most common symptoms are:

·     A popping sound in the knee at the time of injury

·     Sudden swelling of the knees

·     Sharp pain in the knees

·     Weakness and instability of the knees

With modern surgical techniques and high skill level of doctors, the success rate of ACL surgery is around 90%. However, as with any other surgery, ACL surgery also carries some amount of risk with it. The most common risks include 

·     Infection – Even though the chances of infection from the surgical wounds are less than 1%, antibiotics would be given after the surgery to prevent it.

·     Blood clot – Again the chances are very less (less than 0.1%), however the doctors may give medication in case you are found to be at risk during evaluation.

·     Knee pain- This is common after ACL surgery with about 2 people out of 10 affected by pain especially around the knee cap after the surgery. However, this can be addressed completely through a full and proper rehabilitation regime.

·     Stiffness- This is also a common complaint which can be managed through an extensive physical therapy rehabilitation program.

As mentioned above, proper rehabilitation program with the help of experienced and qualified physiotherapists can greatly help in reducing the risks. We can also help in getting you the right therapy support during your stay in India. 

While you will be able to walk properly without crutches after 10 days of ACL surgery, complete recovery may take around 6 months. A well restructured ACL rehab protocol is extremely important for a quick recovery. Doctors would suggest an appropriate rehabilitation program for you which will then be administered by qualified physiotherapists. 

Your recovery program would typically be along the following path

Immediately after Surgery

You will be given crutches while you are still at the hospital. There will also be an explanation and demonstration of the exercises that you will have to start immediately. 

Weeks 1 & 2

The main focus during this period is to reduce swelling in the joint, increase the range of motion in the knee and to start walking again without crutches. You will be on crutches normally for 7-10 days after the surgery. You may be given pain killers in case the pain is persistent. Physical therapy regime should start extensively during this period with focus on knee movements – bending, straightening and raising the affected leg. 

Weeks 2 - 6

By now, swelling and inflammation would have settled. The key objective now would be to strengthen the leg muscles especially quadriceps. More intense exercises and activities like swimming and cycling will be recommended during this period.

If you have an office/desk job, you could start working from week 3 or 4 onwards. You could also resume driving the car in 3-4 weeks after the surgery. 

Weeks 6-24 

You will be able  return to normal activity during this period except sports which require sudden turning, twisting, stopping or turning. 

If you are doing a manual job, you will be able to return to work by around the 12^thweek. 

You will be able to return to active sports in about 6 months’ time.

Depending on the stage and grade of the tear and your lifestyle, you may be able to continue without a surgery. However, in most such cases, you may not be able to  participate in active sports engagements without a surgery. If your knee doesn’t feel really unstable, you may not feel the need for an ACL surgery. Mild tears and low grade tears can even be resolved through extensive rehabilitation programs. Traditional Indian medical system of Ayurveda also offers effective treatment for ligament tears. 

The most important parameters that you should consider before deciding on the surgery are

a.     If you are into active sports, whether you intend to continue in sports. If yes, surgery would most definitely be required

b.     Can you undergo the extensive post-surgical rehabilitation program? If no, surgery may not be the best option for you.