Type of ACL Reconstruction
Selection of Graft
The surgical ACL reconstruction is done using grafts, these grafts maybe
- Autografts –tendons from patients own body usually
- Quadriceps tendon graft or
- Hamstring tendon graft or
- The patellar tendon graft
- Allograft – tendons taken from the deceased donor. Usually autografts are preferred over allograft as the likelihood of rupturing again is minimal as also the chances of secondary infection less and Hamstring tendon autograft has an added advantage that it regenerates over time making the graft more stable.
Symptoms of ACL Rupture are
- Severe Pain
- Swelling in the injured knee
- Loss of stability while walking and loss of motion range
- Many hear or feel a Pop in knee when ACL injury occurs
It is important to have accurate diagnosis and knowledge severity of injury
- Clinical examination: Physical examination is done to understand the type of injury wherein the doctor will access the function of knee joint by moving it in different positions.
- Pivot shift test: One of the main tests to understand ACL injury or laxity , it tells about the unstability. If test is positive a subluxation will occur at 20 to 40 degree of flexion which shows ACL damage.
- Anterior drawer test: Clinically done in cases of suspected cruciate ligament rupture, the patient is made supine , with hip flexed at 45 degree , knee flexed to 90 degree, hamstring relaxed, and then pulled posterior to anterior direction, excessive displacement of tibia anteriorly suggests that ACL has traveling tear.
- Lachman test: Also clinically performed by the orthopedician to diagnose rupture of anterior cruciate ligament, if the test is positive there will be increased forward/upward movement of tibia and a significant soft end point when this movement ends.
- X-ray to rule out fracture
- MRI to evaluate ACL injury and also to see if there is more damage to other knee ligaments, tendons
- Routine tests to declare you fit for surgery
During the Procedure
- The surgeon will make around 2-3 small incisions around the damaged knee.
- An arthroscope that is a thin tube fitted with a fibre optic camera which allows the surgeon to see inside the knee clearly is inserted through one of the incision.
- First of all the torn ACL is removed and the area is cleaned.
- Through the other incision surgical drills are put in and small holes are made into the femur and the tibia.
- The graft is then passed through these holes and held in place with screws or plugs or staples.
- During the surgery if the surgeon feels the other ligaments , tendons , cartilage of the knee are also damaged he may repair them.
- Incision in skin then closed with stitches or staples.
- Care is to be taken to keep the incision area dry and clean to avoid infection.
- You may need to wear a knee brace for 1-4 weeks as also you will need physical rehabilitation to help gain back the stability and function of the knee joint which may take around 4-6 months.
Factors Affecting the Cost of ACL Reconstruction Surgery
Following are the factors which will affect the treatment cost:
- The hospital the patient is opting for
- Room– Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service)
- Operating room, ICU charges
- Fee for the team of doctors (Surgeons, Anesthetist, Physiotherapist, Dietician)
- Standard test and diagnostic procedures
- Cost of the follow– up care which is required after the procedure
- Hospitals in India provide ACL– reconstruction treatment at a cost that comfortably comes under the patient budget
Recovery from ACL Reconstruction
Patient may have to wear a knee brace for the first 1 to 4 weeks & may need to wear crutches for 1 to 4 weeks. A follow-up appointment with the doctor or surgeon will be within a few weeks of surgery. Complete recovery will often take 4 to 6 months.