What is ACL Surgery?
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 originates from the lateral condyle of the femur and attaches to the area between the inter-condylar eminences of the tibia. Its major function is to prevent the anterior translation of the tibia relative to the femur. It is 3.5 cm long and 1.1 cm wide. It is made up of two bundles namely anteromedial and posterolateral bundles.
ACL injury causes:
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:
a. Sudden slowing down and change of direction or cutting. E.g.- Football, Rugby, Cricket
b. Pivoting on a firm foot. E.g.- Basketball
c. Landing from a jump incorrectly or landing on a single leg. E.g.- Volleyball, Basketball
d. Stopping abruptly. E.g.- Tennis
e. 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. Also, persons in the age group of 15 to 45 years are more affected, maybe due to their more active lifestyle.
Symptoms of ACL Injury or ACL tear:
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
ACL injury diagnosis and confirmation:
Lachman’s, pivot shift, and anterior draw are some of the clinical tests to assess the movement of the knee. Confirmation is established by doing an MRI scan that gives a picture of the true extent of injury.
ACL Reconstruction procedures:
ACL reconstruction is done by using a graft tissue to replace the torn ligament. The graft is usually sourced from the patient’s own body (autograft) to reduce chances of rejection. Patellar or hamstring tendons are most commonly used to harvest the graft. Quadricep tendons may also be used in certain cases.
As in any other surgery, ACL reconstruction surgery can be done through open or arthroscopic methods. Open surgery involves a large incision and a correspondingly longer recovery time. Since arthroscopic surgery leads to faster healing and fewer postoperative complications, more number of surgeries are done by this method.
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.
Cost of ACL surgery in India
ACL surgery cost in India is between 2500 USD and 6000 USD. Cost includes Room charges for the specified period, Doctor Consultation Charges, Surgery Fees, Procedure/Consumables charges, Nursing Charges, Medicines/Discharge Medicines and Blood Investigations related to the Procedure.
The factors that affect the cost are many and includes type of hospital, city, room type in the hospital, type of graft, experience of surgeon etc.
ACL surgery recovery procedure and duration:
The duration of hospital stay is usually in the range of four to six days. Recovery from the surgery is a gradual process that passes from a period of complete rest to mild activity to moderate activity. Physiotherapy regimes are to be undertaken during all the phases to strengthen the joint and to bring the knee back to normal. The approximate timeline is about three to six months for total recovery but can vary.
ACL surgery and rehabilitation in India:
While all major hospitals undertake all types of knee ligament surgery, it is advisable to select the right hospital and surgeon with experience in ACL surgery and/or sports injuries. It is a good idea to check on the rehabilitation facilities offered in the hospital as well. Cost of ACL surgery is India is about half of the cost in US, Singapore, UAE etc. Another advantage that India has related to ACL or sports injuries are the rehabilitation facilities provided by Ayurvedic hospitals in India. Some of the best Ayurvedic hospitals in India have specialised treatment for ACL injury rehabilitation.
Dos and Don’ts before and after the treatment:
§ Take medications as prescribed by the doctor