ACL Tear

What will happen if you don’t take any treatment for your ACL injury?

Partial ACL tear { grade1, 2, sprain }

If you delay the treatment it will progress to complete ACL tear and then you will lose the chance of healing without surgery and have to go for arthroscopic all inside acl reconstruction with Fiber tape internal brace.

Complete ACL tear {grade 3, near complete}

Waiting more months will lead to knee cartilage, meniscus, and thigh muscle degeneration. With the torn anterior cruciate ligament the knee undergoes rapid degeneration and leads to secondary osteoarthritis very early and you will require total knee replacement surgery. Treatment is very important to prevent osteoarthritis, to maintain an active life and prevent total knee replacement surgery. After all-inside anterior cruciate ligament reconstruction with Fiber tape internal brace, the patient can resume running and sports within 3 months of surgery.

What is the average cost of anterior cruciate ligament ACL reconstruction \ repair in India?

• Cost of ACL surgery depends on a variety of factors like the quality of the hospital, the healthcare facility you choose, technique of surgery, quality of ACL implants, doctor expertise, pre-evaluation of overall health of the patient. India is amongst one of those countries where you can get access to the best and most advanced ACL reconstruction or repair at a very low cost expense as compared to the European and American hospitals.
• Doctors in India are very professional and Expert, the number of ACL/PCL reconstruction in India is estimated to be 5+ million.
• Our package cost of all inside Anterior cruciate ligament ACL reconstruction with Fiber tape internal brace { implant by Arthrex made in USA } is 160000 to 300000 INR { 2200 to 4200 USD } , Depending upon which room category you choose in the hospital and the quality of the implant.
• Dr. Manu Bora has a hundred percent recovery rate till date by using Fiber tape internal brace arthroscopically, which is a very advanced procedure then the traditional bio screw method. Fiber tape internal brace has very good results in ACL reconstruction, within a month you can start jogging and within three months you can go back to your sports/running. We are offering the best price in India with this technique.
• Price of ACL reconstruction with bio screw technique is lower than the Fiber tape internal brace technique because of the low price of bioscrew.
• Additional costs include rehabilitation and surgery of other associated knee injuries like meniscus, PCL, MCL, LCL etc. No ACL surgery can get the best recovery and result without physical therapy, and physical therapy costs are excluded from the surgery amount.

What is ACL?

You may have heard about ACL, let’s talk about what it is, and how it works. ACL/ anterior cruciate ligament found deep within the knee joint. Our knee joint is primarily made of three bones, femur, tibia and patella. For optimum functioning of the knee joint many structures are involved like bone, muscles, ligament, cartilage, Bursae and many small structures. Ligaments are the most important structure which provides stability to the joint. The ACL is a ligament connecting two bones, femur and tibia. ACL is made up of type1 collagen which is found in bone and soft tissue all over our body. The ACL is made structurally in such a way that it protects the knee joint throughout the range of motion. ACL has two bundles anterior medial and posterior lateral. When the knee is flexed or bent, the anteromedial bundle of the ACL ligaments gets tightened in order to protect excessive moment. Posterior medial bundle gets tightened when the knee extends or straightened. The ACL also gives protection and stability to the knee while the leg rotates. The ACL gets injured in most of the athletic activities but you don’t have to be a professional athlete to tone your ACL, most of these injuries occur within the same mechanism. Let’s try to understand what happened inside the joint and what force caused the ACL injury.

Why is the ACL more commonly injured? because it is directly placed in the middle of the knee joint. Any twisted and direct force can cause injury to the ACL.

Non-contact ACL injuries – means when you don’t fall or hit by any other objects.

• It usually happens when the person or athlete is cutting, pivoting, jumping, stepping and landing awkwardly from jump land his foot awkwardly leading to twisting in the knee.
• It happens when the person transfers the weight and twists the hip, causing a significant torque on the knee joint. This is called a dynamic mechanism of injury.

Contact ACL injuries – ACL tear comes as a result of direct hit or blow on the knee while any object or by any other person.

• With this type of force usually other structures of the knee joint might get involved because of the external force.

Symptoms of ACL injury

People or athletes always present their symptoms like- ‘ I plant my foot, I felt my knee got twisted, the pop sound came and I was unable to continue the game.

However it is very rare but possible that a player injured his/her ACL but continues to play and later after the knee starts hurting, unable to move and swelling occurred; or they present whenever I walk on any ‘uneven surface’’ or inclined surface’ I felt instability in my knee. They feel that the knee is giving away.

Pain – Pain is very sharp, like cutting pain and can make you unable to move or lift the leg.

Swelling – There will be some swelling immediately after the injury but in some cases the swelling is progressive for next 24 hours. It can last up to a week.

Giving away – lack of confidence while walking, running or walking on an uneven surface or inclined surface, feeling of instability in the knee.

• Laxity in the knee joint.
• Feeling of shin bone moving excessively forward.
• In common words the feeling of dislocation of the knee can happen if I walk or run. Painful weight bearing.

What are the types of ACL injuries?

There are three grade

• Grade 1- The fibres of ligament are stretched but there is no tear, the ligament can still keep the knee joint stable.
• Grade 2- The fibres of anterior cruciate ligament are partially torn means half fibres of ACL are torn or incomplete tear with hemorrhage, the ACL cannot provide full stability of the knee joint. Prognosis of grade 2 partial ACL tear is poor and requires surgery.
• Grade 3- The fibres of ACL are completely torn means it’s completely torn into two parts. Grade 3 is the most common type of ACL injury.

Manual test to confirm ACL tear

• 1. Anterior draw test : Patient position is Supine. The knee is flexed or bent about 90°, examiner sits on the toes of the testing extremity to help stabilise. The examiner grasps the proximal tibia just below the knee joint and attempts to translate the tibia anteriorly.The test is considered positive if there is a lack of hard end point or excessive anterior translation relative to the contralateral or non-injured leg.
• 2. Lachhman test patient position is supine lying. Place the testing extremity in 20 to 30° of flexion, the examiner places one hand behind the tibia and other on the patient’s thigh. The examiner thumb should be on tibial tuberosity, leg should be in externally rotation position. On pulling the tibia anteriorly, anterior translation of tibia associated with the soft feel indicates the positive test. More than 2MM of anterior translation compared to the un-involved knee suggest ACL tear.
• 3. Pivot shift test The patient lying supine with the leg relaxed, examiner grasps the heel of the patient’s involved leg and examiner’s opposite hand placed laterally on the proximal tibia just distal to the knee. Apply a valgus force and an axial load while internally rotating the tibia as the knee moves from fully extended position to flexion, subluxation of tibia indicates the positive test while the femur rotates externally.

Management of ACL injuries

Injuries to the ACL rarely occur in isolation. the presence and extent of other injuries may affect the way in which the ACL injury is managed. Confirm diagnosis with MRI and physical assessment gives the absolute best assessment of ACL and other associated injuries.

Surgical or non-surgical management of an ACL tear is analysed through all the above diagnosis and the assessment.

Prevention of ACL injuries

Females are more prone to torn their ACL as compared to males because of Anatomical wider pelvis, decrease in ACL circumference, increased Q- angle, small and narrow intercondylar notch width and Hormonal factors like pre-ovulatory Phase of menstrual cycle.

However muscular and neuromuscular risk are easily modifiable, and gate correction, knee valgus correction, activation of quadriceps and hamstring muscle, agility training and plyometric training reduces the chances of ACL injury.

FAQs

What is the ACL?

The anterior cruciate ligament is present in the center of the knee and it functions as the main stabilizer of the knee. It is a strong ligament that connects the upper thigh bone femur to the lower Shinbone Tibia. It prevents the anterior translation of the Tibia with respect to the femur. It allows smooth movement of the knee without pain and without the feeling of instability.

How does acl injury occur?

An ACL tear is one of the most common ligament injuries of the knee. It can tear during non-contact trauma or direct hit to the leg. There are few specific non-contact trauma in which chances of ACL injury are high like jumping and landing on the foot with your knee collapse inwards, pivoting and cutting movements, sudden twisting and turning.

What is the age group in which ACL tears occur the most?

Research has shown that the most common age group for males to get ACL injury is 19 to 25 years. In females, it is more common between 14 to 18 years of age.

An ACL injury is more common in females?

There is an 8 times higher risk of ACL injury in female athletes. This is due to female leg alignment and increased elasticity of the tissues.

What are the signs and symptoms of an ACL tear?

There might be a loud pop sound during the time of injury and your knee will be painful and swollen. While running and walking you might feel that the knee is not stable and there is a sensation of giving away in the knee. There can be associated symptoms of knee locking and clicking.

What should I do if I think I have injured my ACL?

After the injury, you should stop playing sports or running and take a rest. You should do PRICE therapy which means Protection, rest, ice packs, compression, and elevation. It is important that you go and meet your physician for further evaluation and Management.

How will my doctor diagnose an ACL tear?

Your doctor will conduct a detailed physical examination of your knee, some of the important physical examination tests for ACL tear are Lachman test, anterior drawer test, and Pivot shift test. A physician will diagnose the ACL tear very accurately with the help of your history and physical examination. He will tell you to do some other investigations like x-ray and MRI to diagnose other injuries which might be associated with ACL tear so that he can treat those injuries as well.

Can an anterior cruciate ligament tear Heal without surgery?

Yes, if the anterior cruciate ligament tear is grade 1 or there is a sprain in your ligament it can be very well healed with orthobiologics.

What are my treatment options if I have anterior cruciate ligament injury?

If you have anterior cruciate ligament sprain, grade 1, or 2 tears we can heal the injury by orthobiologics. If your MRI shows that you have grade 3 tears or completely torn anterior cruciate ligament injury then you will require keyhole arthroscopic ACL reconstruction in which a new ACL is made from your hamstring tendon. You will achieve the fastest recovery with all inside ACL reconstruction with Fiber tape internal brace. After this surgery the patient can walk the next day without any pain or support, can bend his knees up to 90 degrees without any pain. The patient will resume jogging after one month of surgery and will resume running and sports after 3 months of surgery. The success rate of all-inside ACL reconstruction with Fiber tape internal brace is more than 99%. If the ACL reconstruction is done by bio screws then it will take 6 to 7 months to resume sports and running, and research has shown 30% failure rates in bio screw surgery.

Can I have reconstruction if I am still growing / in children?

Because of the technical and implant advancement, we can do the ACL reconstruction without hampering the growth plate. If the patient comes to us within a few weeks of the injury we can also do ACL repair in which the ACL tear is repaired and it is not replaced or reconstructed. ACL repair Does not harm the growth plate.

Is ACL surgery worth it? or Are there risks to delaying my Acl reconstruction?

The anterior cruciate ligament is the main knee stabilizer, and it provides stability to the knee. When your anterior cruciate ligament is torn then your knee will become unstable and you will have a feeling in the knee, it will be difficult for you to do sports and running. Waiting more months will lead to knee cartilage, meniscus, and thigh muscle degeneration. With the torn anterior cruciate ligament the knee undergoes rapid degeneration and leads to secondary osteoarthritis very early. Treatment is very important to prevent osteoarthritis and to maintain an active life. After all-inside anterior cruciate ligament reconstruction with Fiber tape internal brace, the patient can resume running and sports within 3 months of surgery.

What are some techniques to reduce ACL injury risk?

ACL injury prevention exercises reduce the chances of ACL injury significantly. These exercises specifically involve core strengthening, balance training, proprioception training, cutting, and pivot techniques. You can see these exercises in my youtube channel {dr manu bora}.

How painful is the anterior cruciate ligament surgery?

If the surgery is done by the bio-screw technique then you might feel pain for a couple of weeks, bending the knee is also quite painful, and complete knee bending will take around 2 months. If the surgery is done by all-inside ACL reconstruction with Fiber tape internal brace the postoperative pain is very less you can bend your knees up to 100 degrees from the next day of surgery and you can easily walk without any support and without any pain, complete knee bending is achieved within 2 to 3 weeks.

What is the fastest way to recover from anterior cruciate ligament surgery?

All inside ACL reconstruction with Fiber tape Internal brace surgery has the fastest recovery. After the surgery, the patient can resume jogging within one month and can resume running and sports within 3 months of the surgery.

Do they use screws in the anterior cruciate ligament surgery?

Yes, most surgeons use a bio screw or titanium screw in this surgery, world research data has shown a 30% failure rate of the screw surgery. If an athlete wants a very fast recovery without any failure then he should go for All-inside ACL reconstruction with Fiber TAPE INTERNAL brace . In this surgery very small adjustable button loops are used for the ligament fixation. Dr Manu Bora uses tightrope and Fiber tape by Arthrex in this surgery. After the operation, the patient can resume running and sports within 3 months.

How long I will be on crutches after anterior cruciate ligament surgery?

If your surgery is done by all-inside anterior cruciate ligament reconstruction with Fiber tape internal brace you will not require crutches for walking. The patient can walk without pain and without crutches after one day of surgery. When ACL reconstruction is done by bio screw or another kind of screw then he might require crutches for walking depending upon how much pain he is experiencing. Generally, the patient uses crutches for two to three weeks after the bio screw surgery.

Is walking good for anterior cruciate ligament surgery recovery?

Yes, the patient is encouraged to do his all daily activities including walking from the next day of the surgery. Walking is important for quick recovery after the ACL reconstruction surgery. With all-inside ACL reconstruction with Fiber tape internal brace the patient can resume walking without pain and without support just after one day of surgery.

How long do you wear a brace after anterior cruciate ligament surgery?

Knee extension brace is given for 3 weeks after the surgery and the patient has to remove the brace while doing exercises.

How long will I be off work after anterior cruciate ligament surgery?

If the surgery is done by all-inside anterior cruciate ligament reconstruction with Fiber tape internal brace generally you resume work after 7 to 10 days of surgery because of fast and pain-free recovery. If the surgery is done by other methods like using bio screws or Titanium screws without internal brace then the patient will require much longer duration at home before joining the work, mostly 45 to 60 days.

How long does anterior cruciate ligament surgery take?

It takes 30 to 45 minutes.

Why is ACL surgery recovery so long?

Because in ACL reconstruction a new ACL is made from the patient’s own hamstring tendon and the tendon is fixed to the bone by a bio screw or adjustable loop button. Recovery is dependent upon what kind of fixation device is used. With bio screw fixation recovery generally takes 6 to 7 months and the patient can resume running and sports after 6 to 7 months of surgery. Surgery done by all-inside ACL reconstruction with Fiber tape internal brace recovery is much faster the patient can resume running and sports within 3 months of the surgery. When a surgeon puts hamstring tendon in the knee as an ACL the tendon takes around 6 months to revascularized and get the strength. Only after that, the patient can resume running and sports. When the surgery is done by all-inside ACL reconstruction with Fiber tape internal brace the Fiber tape internal brace takes away the stress from the healing tissue and patient can resume running and sports after 3 months of surgery and chances of graft lengthening and re-tear is reduced significantly.

Is it bad to wait for ACL surgery?

Most of the patients come for the surgery within one or two months of the injury. Waiting more months will lead to knee cartilage, meniscus and thigh muscle degeneration. Ideally, the patient should wait for 1 to 2 weeks so that the inflammation and swelling subsidize and then he can undergo surgery. If the patient comes within 3 to 4 weeks of injury then ACL repair with Fiber tape internal brace is a better option then ACL reconstruction in selected cases.

Can you walk with a torn anterior cruciate ligament?

After the anterior cruciate ligament tear, you might experience pain and swelling for a couple of days after that the pain and swelling will subsidize and you can be able to walk with an anterior cruciate ligament tear.

How serious is torn anterior cruciate ligament?

Generally, people can do their normal activities including walking but it is difficult for them to do running and playing sports because of the instability of the knee. If they don’t go for ACL treatment then their knee will get degeneration and osteoarthritis will develop in 10 to 15 years after the tear.

Is anterior cruciate ligament surgery a major surgery?

Anterior cruciate ligament surgery is done by arthroscopy, it is a pinhole surgery. It has a very fast recovery with minimal pain and minimal blood loss.

Can I Climb stairs after the anterior cruciate ligament surgery?

Yes, when we do the surgery with All inside ACL reconstruction with Fiber tape internal brace the patient can climb stairs after one day of surgery.

 

What happens if ACL injury is not treated?

If the patient doesn’t take any treatment for his torn anterior cruciate ligament then he will not be able to pursue his daily active life like running, dancing, playing sports. The thigh muscles will get degeneration and become thin. Due to constant instability of the knee, the cartilage and other structures in the knee will also degenerate rapidly. Secondary osteoarthritis of the knee will develop in a few years.

How do you tell if an ACL is torn or sprained?

If the anterior cruciate ligament is completely torn then the patient will feel instability in the knee, it will be difficult for the patient to do active sports and running and he will experience regular twisting of the knee.

What is worse: ACL or MCL tear?

Both anterior cruciate ligament and the medial collateral ligament are very important for the stability of the knee. If anyone of them is completely torn then it has to be reconstructed surgically.

How do you tell if you Retore your ACL?

You will feel the same symptoms of knee instability and loss of confidence if your anterior cruciate ligament is torn again

What does a torn ACL feel like after a week?

After a week of injury, the pain and swelling in the knee subsidize. If the anterior cruciate ligament is completely torn then you will feel instability in your knee and you will lose confidence in running and playing Sports

Can I live without an ACL?

Living without anterior cruciate ligament is like living without running, dancing, and sports. Your knee will develop osteoarthritis after 10 to 15 years and you will require total knee replacement surgery in the future.

How do you strengthen your ACL?

By doing anterior cruciate ligament injury preventing exercises an athlete can prevent his anterior cruciate ligament from getting injured.

What exercises will strengthen my ACL?

Strength training including eccentric exercises, balance training, proprioception exercises & functional drills can prevent the anterior cruciate ligament from getting injured.

Does a Grade 1 ACL tear need surgery?

Grade 1 anterior cruciate ligament tear can be healed completely with orthobiologics treatment; it really needs surgery.

How much does ACL surgery cost?

Arthroscopic all-inside anterior cruciate reconstruction with Fiber tape internal brace cost from 1.7 lakh to 3.5 lakh rupees depending upon which implant and what room category you choose in the hospital.

How successful is ACL surgery?

Arthroscopic anterior cruciate ligament reconstruction has a 99.9% success rate after all-inside anterior cruciate ligament reconstruction with Fiber tape internal brace then the patient can resume running and sports within 3 months of the surgery. Arthroscopic ACL reconstruction with bio screws has a 70% success rate.

Is surgery always needed for a torn ACL?

If an anterior cruciate ligament tear patient is young and does not have any symptoms of high-grade osteoarthritis, it is advisable to go for the surgical treatment to prevent the Rapid development of knee secondary osteoarthritis.

Why do ACL reconstructions fail?

Anterior cruciate ligament reconstruction surgery fails if the surgery is not done accurately or the screw got loose or inadequate rehabilitation or if some complications like infection develop in the postoperative period and there is a 30% failure rate with bio screw surgery. With all-inside ACL reconstruction with Fiber tape internal brace failure rate is negligible because Fiber tape acts as a seat belt of new ACL, preventing it from graft failure, loosening, and stretching.

What can go wrong with ACL surgery?

Accurate placement of femoral and tibial Tunnel is very important in the success of anterior cruciate ligament surgery if during the surgery tunnel placement is not accurate than the anterior cruciate ligament surgery might fail in the future.

Is second ACL surgery easier?

Second anterior cruciate ligament surgery is challenging as there is an implant present in the Tibia and femur, this implant might be a screw or an adjustable loop button. Second time or revision anterior cruciate ligament surgery is done with screw fixation has a higher chance of failure because of the widening of the tunnel and a loose graft. All-inside anterior cruciate ligament reconstruction with Fiber tape internal brace is better for a revision anterior cruciate ligament surgery as the fixation is not dependent on the intramedullary bone and tunnel condition, in this the fixation is on the cortex.

Is ACL surgery safe?

Yes ACL surgery is safe.

Can an ACL tear heal without surgery?

Yes, if the anterior cruciate ligament tear is grade 1 or there is a sprain in your ligament it can be very well healed with orthobiologics.

How soon can you walk after ACL surgery?

If the surgery is done by all-inside anterior cruciate ligament reconstruction with Fiber tape internal brace you can resume walking without any support and without pain in just one day after surgery.

What is the fastest way to recover from ACL surgery?

All inside ACL reconstruction with Fiber tape Internal brace surgery has the fastest recovery. After the surgery, the patient can resume jogging within one month and can resume running and sports within 3 months of the surgery.

Information:If you are suffering with a painful knee condition or have limited mobility due to a knee problem, contact Dr. Manu Bora to schedule an exam and evaluation. We accept many forms of insurance at our clinic for your convenience.