ACL Surgery in Delhi

There are three types of ACL injury:

• Grade 1 is mild and often referred to as a sprain of a ligament in MRI reports. The fibres of the ligament are stretched, but continuity is present.
• Grade 2 is a moderate injury where a partial tear means many fibres are torn, but continuity is maintained.
• Grade 3 is the most severe type in which complete ligament rupture or tear and continuity are absent.

Tibial spine avulsion, in this case, acl is not torn, but the attachment of acl to the shin bone is broken with a chunk of bone attached to the ligament.

Symptoms include

• Pain
• Swelling in the knee joint
• Not able to maintain balance at the knee joint
• Initial period patient will not be able to keep weight on the affected leg.

Diagnosis includes detailed medical history, physical examination, x-ray, and MRI of the knee joint.

Grade 1 ACL injury is treated with

• Rest
• Physiotherapy to strengthen muscles around the knee joint
• Ice packing
• Pain medication
• Braces for a few days help.

This grade is usually treated without surgery, and recovery is relatively fast.

Grade 2 of ACL injury treatment depends on

• Age of patient
• Activity level of patient
• Continuous pain in the knee joint
• Instability or difficulty in maintaining balance at the knee joint

In most cases, grade 2 patients who are elderly or have a lifestyle that requires less physical activity and not indulging in sports or gym activities can be managed with physiotherapy to strengthen muscles around the knee joint and rest. But persons who want to indulge in sports or have quite an active lifestyle with lots of physical work will require ACL reconstruction surgery.

In these cases, the patient will require ACL reconstruction surgery, but a few cases can still be treated without surgery, which depends on the patient's age and level of activity.

As discussed in detail, treating ACL depends on the grade of injury, age of patients, and activity level of patients. It can be managed without surgery in cases of grade 1 and some cases of grade 2.

In ACL deficient/absent knees

• Damage to cartilage or early-onset osteoarthritis may occur
• Damage to the meniscus (acts as cushion/shock absorber in the knee joint) may occur
• Chronic knee pain and difficulty in maintaining balance may occur

No complete ACL tear can't heal on its own.

Immediately after having an ACL tear, there will be

• Pain in the knee joint
• Swelling of the knee joint
• Loss of stability or patient will not be able to maintain balance at the knee joint

But usually, after 3 weeks, the swelling will subside, and the pain will decrease. After a month, you can walk, but stability and difficulty in maintaining balance at the knee joint will remain.

As such, there is no uniformly accepted Ideal age for ACL reconstruction surgery, but it depends on:

• Patients physical condition or activity level the person
• Lifestyle of the patient or indulgence in sports/ heavy work
• If there is a continuous problem of knee instability/ problem in maintaining a balance of the knee joint.
• Having problems in doing daily activities like using stairs, gymming, enjoy dancing, exercise, sports activities, cycling, weight lifting, squatting, and heavy fieldwork.

ACL reconstruction is the surgical treatment of ACL injury in which a graft is taken from the patient's body and is secured in its place where the previous ligament was attached.

• Proper positioning of the graft is of utmost importance. Most cases of reinjury or failure of reconstructions occur due to wrong or misplaced positions of tunnels inside the femur or tibia bone. A good surgeon always focuses on making the tunnel accurate, as differences in position (in millimetres) can cause increased failure rates.
• We also preserve previously torn acl as it helps preserve proprioceptive nerve endings, which makes post-surgical healing natural and results in complete natural recovery. Preserving original acl tissue also helps reduce the chances of reinjury and prevents Osteoarthritis.
• Ligament is secured in place with the help of fixation devices.

Fixation devices most commonly used are buttons and screws in ACL reconstruction surgery.

Button with threads attached to them used in ACL reconstruction surgery fixes graft to femur and tibia. These can be from different companies and are used depending on surgeons' preferences. Most commonly used to attach the graft to the femur/ thigh bone, in all inside ACL reconstruction technique, they are also used to connect grafts to the tibia/ shin bone.

Screws used in ACL reconstruction surgery can be bioabsorbable or hydroxyapatite coated.

• Bioabsorbable screws dissolve inside the bone. These screws are usually absorbed within 2 years and don't cause inflammation, clinical problems, or reactions. But further studies are required to know about detailed properties.
• Hydroxyapatite-coated screws.

Hydroxyapatite is naturally present in the bone and teeth of humans up to 50% volume and 70% weight.

• Screws coated with hydroxyapatite have a natural tendency to fix the bone.
• They also help in increased bone formation and better healing.
• Reduces infection risk
• Fewer chances of allergies or other sensitivities
• Better for x-ray and other imaging as they are radiopaque hence better visibility.

The ultimate decision of choosing between types of screws should be taken in consultation with the surgeon.

This technique is reserved for only ACL tears in the proximal portion or an incision near the thigh bone or femur. This is one of the new techniques which is in use. This technique involves Acl repair instead of ACL reconstruction, no graft is taken, and the original ACL is repaired. Fibre tape is used to provide strength to repair ACL.

Although it provides better functional outcomes, few studies support the current concept. Many studies have concluded no difference between ACL reconstruction and acl repair with the internal brace technique. Detailed studies are further required to provide depth knowledge.

ACL reconstruction surgery can be performed in young and skeletally immature patients. In consultation with the surgeon, an informed decision should be taken.

Stem cells use is right now in the experimental phases for ACL injury. Many countries, including the United States, don't allow the use of stem cells for the treatment of ACL injuries. If a patient has severe ACL injury, ACL surgery should be considered instead of stem cells. 

Acl reconstruction surgery should not be delayed for long as it can cause increased damage to the knee joint, and the chances of injuring other structures like the meniscus increase. If you are planning to delay surgery, you must perform low-impact activities and don't do sports or heavy workouts.

Usually, it depends on the patient's medical condition; if the patient is not suffering from any disease before surgery, hospital stay is for 1-2 days.

You can shower within 2-3 days after ACL reconstruction surgery. Usually, waterproof dressing is applied to the wound, after which the patient can shower. But to take a bath or swim patient will require 4-6 weeks. The patient has to keep the wound dry and avoid using hot water as it increases swelling.

You can usually drive after ACL reconstruction surgery after 3- 6 weeks. But it has to be consulted with a surgeon and physiotherapist.

A patient can walk on the next day of ACL reconstruction surgery with support and after 2 weeks without support. After which the patient will have to follow a regular physiotherapy routine for several weeks. Patients can start their low-impact activities after 4-6 weeks, like driving, car walking short distances, and squatting under proper supervision; after 2 months, jogging can be started; complete recovery of patients will take 6-9 months.

Usually, if the patient's office work involves a desk job and no heavy work activities, he can join the office in 4- 6 weeks. In case it's a field job and requires heavy work activities, it may take 6-8 weeks.

Usually, if there was only ACL reconstruction done, then the patient will be able to run after 4 months of proper physical therapy. But it depends on the amount of damage to cartilage and strength of the quadriceps muscle; otherwise, chances of developing swelling in the knee joint and cartilage damage increase.

It depends on the recovery course of the patient after ACL reconstruction surgery, but usually, patients can get back to sports in 9-12 months. Initially, some surgeons started to decrease recovery duration to 5-6 months, but it was observed in various studies that chances of failure have increased. We follow the international standards of proper rehabilitation and advice our patients to return back to sports after 9-12 months after appropriate physical training. We should follow the latest, best, and thoroughly studied techniques and provide results comparable to international standards.

Yes, there are chances of failure of ACL reconstruction. It depends on the risk factors Positioning of graft- this is the most crucial factor which decides the success of acl reconstruction surgery.

In a few cases if damage to other structures is missed, like the medial collateral ligament. Posterolateral complex, medial meniscus tear chances of retear/ failure of ACL reconstruction increases. But if ACL reconstruction surgery has gone uneventful with proper rehabilitation, chances of retear do decrease.
 

If a person has failed ACL reconstruction, treatment involves revision ACL reconstruction or going for ACL reconstruction again. With the increase in ACL reconstructions performed worldwide, ACL reconstruction failures have also increased.

It depends on the hospital category chosen by patients and the type of implant discussed. At Simpainortho.com, we have tried to reduce the cost of surgery and hospital expenses and included complete after-surgery services, which patients require after surgery because we know treatment doesn't end at the patient's discharge. To ensure the quick recovery of patients in simpainortho.com, a patient requires expert care within the most comfortable surroundings until he can join routine activities. So, we have made different packages for different patients according to need, and that too at the most affordable prices.

Yes, most of the insurance has included ACL reconstruction surgery.