The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is located in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with the posterior cruciate ligament (PCL), it provides rotational stability to the knee.
The main function of the ACL is to provide stability and strength to the knee when it moves from one side to the other side. The ACL Reconstruction surgery is performed in order to repair a torn ACL and re-attain the movement and the lost stability. The doctor advises this reconstruction surgery only for athletes, young people or the ones who have severe and intolerable pain.
How is ACL Injured?
An ACL injury is a sports related injury that occur when the knee is forcefully twisted or hyperextended. An anterior cruciate ligament tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.
ACL Tears can occur if you make sudden, sharp movements or suddenly change direction of movement. ACL helps keep the knee joint stable and plays a key role in mobility and range of motion. It’s damage can cause loss of stability, frequent falls and give ways. This can in turn lead to damage to other parts like cartilage and menisci of the knee.
If you strain or slightly tear your ACL, it may heal with doctor’s help and physiotherapy. However, if your anterior cruciate ligament is completely torn surgery might only be the option for you. Women are at higher risk of sustaining an ACL injury than men. Potential reasons for this increased risk may include differences in anatomy, training, and activity experience. The patient usually can notice a loud popping sound as the ligament tears. Patient may also have swelling and inflammation.
ACL Reconstruction Surgery:
In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor. This surgery is an outpatient procedure that’s performed through small incisions around your knee joint. The whole procedure is done through a telescope inserted through a key hole in the knee joint. The torn ligament is replaced by an autograft taken from the tendon around the knee joint. We use hamstring tendon (sometimes the Patellar tendon). The tendon is stitched up and passed through tunnels drilled in bone of the knee joint. It replaces the torn graft and is fixed through special implants, which protect the graft.
Different grafts can be used to replace and reconstruct ACL. The two main types of grafts used are Bone-patellar tendon- Bone and Hamstring grafts. The bone patellar tendon bone graft is a strong graft, however can give rise to problems like anterior knee pain. They are still gold standard in athletes. Hamstring grafts are very patient friendly in terms of pain and post op recovery. They are most commonly used for ACL reconstruction. In case of B-Pt-B graft, the new ACL is harvested from the patellar tendon that connects the bottom of the kneecap (patella) to the top of the shinbone (tibia). In case of Hamstring grafts, its harvested from antero-medial aspect of shin of tibia. The procedure is performed under general anaesthesia. Your surgeon will make two small cuts about ¼ inch around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the knee to expand it providing the surgeon a clear view of the inside of the joint. The torn anterior cruciate ligament will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The use of bio-absorbable screws improves the healing of the graft. The incisions are then closed with sutures and a dressing is placed.
Key Benefits of ACL Reconstruction:
1. It is one of the most common arthroscopic surgeries done through small, keyhole incisions.
2. A graft from muscle around the knee is taken and prepared to replace the native ACL.
3. Arthroscopic anterior cruciate ligament reconstruction is a patient friendly procedure. It results in lasting results and return to normal function.
4. It has very short hospital stay and is hardly painful.
5. It needs thorough and home based rehabilitation post-surgery to derive maximum benefits of surgery.
Rehabilitation after ACL Reconstruction Surgery:
1. The rehabilitation post procedure is not painful and not difficult.
2. The exercises programs are home based and don’t need frequent visits to therapist.
3. The initial focus is on strengthening muscles around the knee.
4. To resume sports a lot of attention is needed to regain proprioception and balance of the knee joint
5. Any sports activity should resume once the strength of the knee reaches 80 percent of strengths of normal knee joint
ACL Reconstruction Surgery Cost in India and Success Rate:
The evaluation and examination for ACL Reconstruction Surgery may costs upto USD 500-1000. However, ACL Reconstruction Surgery costs around USD 3500- 5000 depending upon the type of procedure, surgeon and the facility where you choose to get the surgery done. The success rate for ACL Reconstruction in India is extremely high and goes upto 98%.