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Department of Arthroscopy
ACL Tear Treatment

Discover the foremost choice for ACL reconstruction surgery at Sri Balaji Hospital, Chennai. Book an appointment today.
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Image of the knees with labelled parts.

Anatomy of the  Anterior Cruciate Ligament

The anterior cruciate ligament is synonymous with providing anterior (in front) stability to the joint. It comprises a thick bundle of ligamentous fibres, which provides a strong connective tissue between the femur (thigh-bone) and the tibia (the leg bone).

Mode of Injury

  • Twisting injury to the knee while turning in the midst of the running motion.
  • Twisting injury to the knee while slowing down moving 2-wheelers.
  • Impact on the knee while in full flight of motion.
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Symptoms of an ACL Injury

Persistent pain (even mild or dull) after 2 to 3 weeks of injury.
History of twisting injury/ improper landing on the affected knee preceding the onset of pain.
Instability of the knee (feeling of slippage/ “giving away” of the knee) while walking. This is usually experienced while climbing downstairs, running, or putting on shoes while standing on one leg/ bending forward.
Associated locking of the affected knee could suggest associated PCL injury or meniscal injury.

What Should You Do?

Ice application
Crepe bandage application
Visit one of our specialists for consultation

Our Specialist’s Protocol for Management of ACL Injuries

Physical examination to confirm the presence of a ligament instability in the knee.
Elicit a thorough history.
An MRI scan may be suggested to confirm the physical finding and also to confirm/rule out associated knee injuries.

Do All Ligament Injuries Require Surgery?

NO. Not all ligament surgeries require surgery.

We at Sri Balaji Hospital follow a grading system to assess and decide the need for surgery or otherwise.

Grade I. A partial tear is present in the ligament.
Grade II. There’s a partial tear, and the ligament feels loose.
Grade III. The ligament is completely torn, and the knee is unstable.
Grade IV. The ACL is injured, and another knee ligament is damaged.

Following the outlined protocol given above, grade II tears are considered as relative indications. Factors such as pre-injury lifestyle and the patient's specific demands are taken into account before determining the suitability of surgery. Conversely, for grades III and IV tears, arthroscopic surgical intervention proves to be highly beneficial in a majority of cases.

We will talk to you and decide on the benefits of the surgery for you and your Pre-injury lifestyle. Our sole objective is to restore your pre-injury lifestyle, ensuring a pain-free and injury-free experience. If the only way to achieve that is surgery, then the same will be communicated to you. However, in contrast, if there is a good enough possibility of attaining those goals non-operatively, that would be our surgeon’s first choice.

Whether to go for surgeries (arthroscopy) or not depends on a multitude of factors, the most important of them being:

Factors such as advanced age, arthritis, prolonged bed rest, or a history of limited activity even prior to the injury may necessitate exploring non-surgical alternatives instead of opting for surgery. Similarly, young (20 to 45 years age group) individuals who lead an active lifestyle with regular and intense physical activity and wish to pursue the same even after the injury will benefit from arthroscopic reconstruction of the PCL.
Partial or mild tears do not require surgery. Even full-thickness tears can be treated conservatively until/unless the patient is symptomatic or experiences instability of the affected knee.
Physical activity associated with the knee
Arthroscopic PCL reconstruction surgeries offer significant benefits to active individuals, regular runners, workout enthusiasts, and athletes.

Surgical Technique

At Sri Balaji Hospital, we employ the cutting-edge Smith & Nephew arthroscopic system, delivering exceptional 4K quality for comprehensive visualisation of the affected joint. This advanced system helps us screen for associated injuries, ensuring a thorough assessment, which is often missed in MRI studies.

The actual procedure involves making 2 key hole-sized incisions (portals) on the front of the knee, one to accommodate the camera and the other portal to make way for the entry of the arthroscopic surgery instrumentation. A third mini-incision may be made to pass the graft or the screw that fixes the muscle or tendon graft.

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Benefits of Surgical Intervention
Complications of Non-Surgical Intervention
  • Quicker healing time.
  • Faster return to activity/ sports.
  • Return to pre-injury levels of physical activity.
  • Less risk of recurrence of symptoms.
  • Risk of continued/ worsening of pain.
  • Risk of continued/ worsening of instability.
  • Reduction in physical activity.
  • Risk of developing arthritis of the affected knee in the long term future.

Reconstruction of the ACL

It involves acquiring a substitute which will mimic the natural ligament closest in terms of strength as well as flexibility of the native ACL. This substitute is termed as a “graft”. This graft is of 2 types:

The muscle graft

It is most commonly acquired from the lower thigh. The muscle of choice will be the semitendinosus, which is then looped 2 or more times to provide the strength to support the body weight of the individual and provide as much strength as will be demanded by the individual's physical activities. This procedure is ideal for individuals who require more flexibility, are not too involved in contact sports, and are less prone to sports-related injuries.

The bone-tendon-bone-graft
This involves the usage of a part of the patellar tendon along with a sliver of bone to provide increased strength to resist future impacts to that knee and shield from high-intensity contact during vigorous sports. However, while the strength provided by this graft is commendable, it unfortunately has a high incidence of reduced flexibility if the post-operative rehabilitation is inadequate.
Model of the human knees.
What Material is Used to Fix the Graft?
Here at Sri Balaji Hospital, we often prefer a “bio-absorbable” material as an implant to fix the graft, as it is known to get absorbed biologically within 12 to 18 months. Hence, there is less risk of implant-related complications and no hindrance to repeat MRI scans in the future. Alternatively, a titanium implant can be used. This material is also MRI-compatible but will physically remain in the body until removed (if necessary).
Post-Operative Period
  • Walk on the same day of surgery.
  • Start knee-bending exercises the next day.
  • Discharge within 24 - 48 hours.
  • Return to office/ school/ college within 2 weeks.
  • Return to vehicle driving within 6 weeks.
  • Return to running/intense physical activity within 6 months.
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Sri Balaji Hospital is a centre for Orthopaedics and Traumatology and is unwavering in its commitment to providing high-quality healthcare at affordable rates. Our dedication stems from the belief that you, the community, are at the core of every endeavour, deserving nothing less than the utmost care.
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