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Last Updated: Feb 12, 2020
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Anterior Cruciate Ligament (ACL) Reconstruction - Treatment, Procedure, And Side Effects

Overview Types of grafts Preparation Method Side effects Recovery time without surgery Recovery time Cost Results Alternatives
Anterior Cruciate Ligament (ACL) Reconstruction - Treatment, Procedure, And Side Effects

What is Anterior Cruciate Ligament Reconstruction?

ACL refers to the Anterior Cruciate Ligament. Anterior Cruciate Ligament with other four main ligaments located in the knee. The knee joint is held together by Medical Collateral Ligament , Lateral Collateral Ligament , Anterior Cruciate Ligament and Posterior Cruciate Ligament.

Being located in the centre of the knee, it helps to keep the shin bone or tibia in place. An ACL reconstruction is a tissue graft surgery to reconstruct or repair the ligament of the knee. A tear of this ligament can become a hazard in your physical activities.

The particular cruciate ligament is usually not required for day-to-day operations, but it is used to control the rotation forces developed during pivoting, landing from a jump or side-stepping. An ACL injury is common while skiing or playing running ball sports. A person may feel to hear a snap or a crack. Swelling and knee pain shortly follows.

The ACL is surrounded by joint fluid, utilized unlike other ligaments about the joint. Other ligaments heal by scar formation, however, due to the unique location of the ACL, the bleeding is uncontained, filling the joints, causing pain and swelling. It can be a small tear for which rest or physical rehab would work well, but if the injury is severe, then ACL reconstruction is to be done.

What are the different types of grafts used for ACL reconstruction?

These are the different types of grafts which are done for ACL reconstruction:

  • Autograft: These grafts are taken out from the patient's body, portions include extensor mechanism, patellar tendon , hamstring tendon , semi-tendinousus tendon, iliotibial tract, menisci and gracilis tendon.
  • Allograft: These grafts are taken from the corpses
  • Xenograft: Grafts from the animals are taken in this type. A high rate of complications has been associated, particularly with bovine xenografts.
  • Synthetics: This type can further sub-classified into 3 classes: carbon fibres , Gore-Tex and Dacron and devices for ligament augmentation.

What is the best graft for ACL reconstruction?

There are many different ways of doing graft for ACL reconstruction and different surgeons prefer different graft methods. Among all these grafting methods the outcome of HT autograft is best than PT grafts and the ACLs which are reconstructed using HT autografts have a lower rate of radiological osteoarthritis.

How long does ACL reconstruction surgery take?

The surgery takes one or one and a half hours to perform and the patient does not need to stay at the hospital for a long time as it is an outpatient surgery. But the planning of surgery may take longer of about three to four hours.

How to prepare for ACL reconstruction surgery?

Physical therapy before ACL surgery:

Physical therapy is often prescribed by the doctors for helping the patient which include:

  • If there is any swelling on the knees it must be reduced
  • The muscles around the knees must be strong if not exercise must be done to make them stronger.
  • The motion range of knees must be normal if not restore it.

Nutrition before ACL surgery:

Caffeine, nicotine, and alcohol must be stopped before the ACL surgery. Nutrition must be included in the diet like multivitamins, vitamin c, zinc, as they all help in healing the wound post-surgery.

What is the best ACL reconstruction method?

ACL reconstruction procedure uses a graft to replace the cruciate ligament. Autografts are the most common grafts which use part of your body, for example, hamstring tendons or patellar tendons or quadriceps muscles. Another form of the graft is allograft in which tissues from a deceased utilized. Arthroscopic surgery is used for an ACL reconstruction.

In this surgery, small incisions are done on the knee through which surgical instruments are inserted. Sometimes it is also done by making a large incision which is called an open knee surgery. Anesthesia would be given at first to immune your knee from feeling anything. During the procedure, an arthroscope is inserted through one of the small incisions. An arthroscope is a thin tube fitted with surgical instruments and a fibre-optic camera.

It helps the surgeon to get a view of the inside of the knee during the procedure. The torn ACL is first removed, and the area is cleaned. Small holes are drilled into the femur bone and the shin bone so that the bone plugs or anchor points to which the new tendons are outfitted, is attached with screws, posts or washers. After the new ligament is attached, the doctor would ensure that the graft is securely placed.

Finally, the wound would be stitched; the knee would be dressed and stabilized with a brace. The duration of the whole surgery would depend on the severity of the problem as well as the experience of the surgeon. Usually, a patient is discharged one or two days after the surgery.

Who is eligible for the treatment?

Usually, an ACL is done when the cruciate ligament that joins the shin and femur bone is injured. The treatment is done if one suffers from persistent knee pain or when the injury causes your knees to buckle while walking and other routine physical activities. Some jobs require one to do leg-work or athletes who want to continue to be in the profession actively can undergo the ACL reconstruction treatment.

Who is not eligible for the treatment?

ACL reconstruction is not meant for everyone with a ligament tear. Children can live without the treatment as their growth plates are still open, leaving a chance of a new ligament growing. There are instances where a ligament injury does not lead to instability symptoms.

If the tear is partial and shows no trouble while engaging in low-demand sports, you can let go of the treatment and resort to nonsurgical treatments like therapy. People doing manual work or lives a sedentary life can also not undergo this treatment.

What are the side effects of ACL reconstruction treatment?

The patient might feel numbness in or around the surgery area. It is rare, but the treatment can damage the nerves or other tissues in or around the knee if the surgery was not done properly. The screws that are attached to the bone can cause problems like loosening and might require removal.

If tissues of a deceased patient are used in the surgery, there remains a high risk of getting infected. Surgery needs to be carried out in a strict non-germ condition in an operation theatre. Despite these measures, there is a small percentage of chance of developing an infection in the joint.

What is the ACL tear recovery time without surgery?

The time for ACL healing without surgery is time taking as it is a lengthy process and requires immense efforts. It needs weekly commitment as there is a requirement of physical exercise.

How long does it take to recover from ACL surgery?

The extent of time that it takes to recover after an ACL reconstruction surgery varies from one person to another. Physical rehab might take up quite a lot of time, from a few months to almost a year. Most people take near about six months after the surgery to return to the routine activities of life.

How much does ACL reconstruction surgery cost in India?

The cost of ACL treatment in India ranges from Rs.75000 to nearly 2 lakhs. It varies with the type of procedure, facility, surgeon, and quality of the implant. After the surgeries there are additional costs of Rs.15000 to Rs.20000 would be incurred in post-surgery physiotherapy or rehabilitation which is essential for a significant recovery.

Are the results of the treatment permanent?

The results of ACL treatment would be permanent most of the time if there were no mistakes in the surgery. It reduces stiffness and consistent pain in the knee. Especially for athletes, it is very much helpful and makes him/her return to the world of action sports.

What are the alternatives to the treatment?

Surgery is a common procedure to repair cruciate ligament tears. But surgeries have their issues, and thus many new and alternative treatments have been introduced. Stem Cell procedure is an alternative to the treatment of ACL reconstruction or repair. It extracts stem cells from an area where it is present in abundance and then concentrating and re-injecting them into the damaged area. The Platelet Rich Plasma and also the Platelet LysateInjection Treatments are an alternative as well. The use of these treatments to repair tendons, ligaments and joints are becoming common nowadays.

Key Highlights

Safety: Medium

Effectiveness: Medium

Timeliness: Medium

Relative Risk: High

Side Effects: High

Recovery Time: High

Price Range: Rs. 75,000 - Rs. 2,00,000 and above

Popular Questions & Answers

Mid and distal ligament partial acl tear and partial root tear of lateral meniscus. Surgery required or not?

Erasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPT
Physiotherapist, Chennai
Surgery is better for acl tear and lateral meniscus tear as you are quite young you can definitely go for surgery.

My brother has gone through arthroscopic acl reconstruction. He has taken paracetamol plus tramadol hcl for eight days (2 times per day) with one day break in dosage. Now he has stopped taking it. Is he going to suffer from withdrawal effects of tramadol? If yes then for how long? Can he take panadol extra as alternative?

Orthopedic Doctor, Mumbai
Hello lybrate-user, your brother will not suffer from any withdrawal effects. But he should avoid taking tramadol for longer duration. He can take other painkillers. Yes he can take panadol as alternative. Thank you.

I used to play football I am 20 now after a match I start feeling instability in my right knee and my mri report says that there is a complete tear of acl so can it be healed without surgery and how much long it takes to recover.

BPTh/BPT
Physiotherapist, Howrah
If it is complete tear then need anterior drawer test. If is done then acl reconstruction surgery is need. Others wish left football ground. As a physiotherapist to say you that you need exercise after and before surgery recovery depends upon to you.

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