Doctors for ACL tear treatment

An anterior cruciate ligament tear or an ACL tear is an injury or sprain on theanterior cruciate ligament in the knee.The ACL is a tissue that connects the thighbone to the shinbone at the knee. In most cases, ACL injury occurs during certain sports, such as basketball, football, skiing, and tennis. Common symptoms of ACL tear include knee swelling, instability, pain, etc.

The treatment option for ACL tear depends on a variety of factors, including the age of the patient, severity of the condition, any preexisting health condition, etc. In severe ACL tears, a doctor usually recommends surgery, while minor ACL tears can be managed by non-surgical treatment options, including pain relief medications and physical and occupational therapy.

Before ACL reconstruction treatment, the doctor first diagnoses the condition to understand the severity of the tear. In general, surgery is recommended for young patients who are active and for those with whom the ACL tear is associated with injury to other structures in the knee. Non-surgical treatment may be recommended in older or more sedentary patients. It consists of physical therapy, activity modification, and the use of a brace. The aim of physical therapy is to strengthen the muscles around the knee to compensate for the absence of ACL.

The main goal of surgery is to restore stability to the knee so it no longer gives out or slides too far forward, which is usually painful. The other important reason is to protect the cartilage in the knee from being damaged.

Listed below are some potential benefits of ACL reconstruction surgery:

• Restoration of knee function: The knee's functionality is hampered by an ACL tear. Surgery is the best way to effectively restore knee stability and function because it addresses the root cause of the problem. It completely repairs the damaged ACL, giving your knee stability again and enabling you to resume your regular activities.
• Permanent symptom relief: ACL tears cause a variety of symptoms, such as moderate to severe pain, instability, lack of functionality, swelling, and weakness. Non-surgical procedures can lessen these symptoms, but they won't repair the torn ACL. Thus, complete symptom relief is likely impossible in most cases. ACL repair surgery permanently eliminates pain, swelling, and limitations in the affected knee joint because it actually corrects the underlying cause. As a result, a surgical procedure is the only method for you to get lasting relief.
• Prevention of further damage: Repairing the torn ACL helps to avoid damage to the surrounding knee structures and cartilage, which would otherwise be prone to increased pressure due to the ACL's inability to function. ACL repair surgery stabilizes the knee and protects the other knee structures from stress and potential harm.
• Use of minimally invasive techniques: ACL surgery can be performed through minimally invasive techniques with the help of an arthroscope, which allows the surgeon to visualize the inner structures of the knee and minimize disturbance to the surrounding healthy tissues. One of the biggest benefits of arthroscopic ACL surgery is that it allows the patient to return home on the same day as the surgery. It also results in less scarring, pain, and risk of infection. Additionally, patients also enjoy a shorter recovery period.

In some cases, untreated ACL tears can lead to total joint replacement. Ligaments do not receive adequate blood supply to heal on their own. If ACL injury is left untreated, it progressively gets worse and leads to the following condition:

• Knee joint instability: A damaged ACL joint typically is unable to bear any weight and becomes progressively more unstable.
• Pain: ACL injuries can cause pain. If not treated on time, the pain increases, and the knee becomes so swollen that it becomes difficult even to move.
• Disability: If treatment is delayed, the knee joint may no longer be able to bend and straighten, resulting in permanent impairment.
• Arthritis: When an ACL is injured, the ligament typically cannot function effectively; instead, the surrounding muscles, tendons, and bone structures endure the stress. Many people can develop arthritis as a result of this increased stress.

ACL injuries typically require 4-5 weeks of rehabilitation, but since athletes place more stress on their joints, they require longer recovery times for better movement. Additionally, it aids in preventing the damage from recurring. Three objectives are typically included during treatment:

• Preserving the joint's stability to aid in healing
• Increasing the joint's range of motion by strengthening the joint
• Improving joint flexibility to lower the risk of re-injury after returning to sports

About 4-6 months following their ACL surgery, most athletes can begin practicing for their sports, but doctors typically advise complete recovery before they resume competition. The entire rehabilitation period can be split into the following:

• Phase 1: 3-4 months after surgery- Regain strength and improve the flexibility of the joint.
• Phase 2: 4-6 months after surgery- Low-level fitness and performance agility drills.
• Phase 3: 5-8 months after surgery- Jumping exercises.
• Phase 4: 6-9 months after surgery- Single-leg jumping exercises.
• Phase 5: 9-12 months post-surgery- Steadily increase sports drills till the former skill is achieved while focusing on preventing re-injury.

Diagnosis usually begins byconducting a physical exam to check the swelling and tenderness in the knee. A healthcare provider also moves the knee into various positions to assess the range of motion and overall function of the joint. In addition, a doctor suggests a variety of imaging tests to identify the causes and to determine the severity of the injury. These tests may include:

• Magnetic resonance imaging (MRI): In this test, radio waves and a strong magnetic field are used to create images of both hard and soft tissues in your body. This test helps to show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage.
• Ultrasound: During this test, sound waves are used to visualize internal structures. This test is also helpful in checking for injuries in the ligaments, tendons, and knee muscles.
• X-rays: A doctor usually recommends X-rays to rule out a bone fracture. However, X-rays don't show soft tissues, such as ligaments and tendons.

Different treatment options for ACL reconstruction surgery are as follows:

• Knee arthroscopy: Arthroscopic surgery is a minimally invasive surgical procedure used to visualize, diagnose, and repair the anterior cruciate ligament using small instruments. During the surgery, a surgeon inserts a thin tube attached to a camera (a fibro-optic camera) into the joint via a small incision on the skin of the joint. Visualizing the joint via a camera helps the surgeon view the inside of the knee and determine the severity of the condition. After that, a surgeon repairs torn tissues, shaves off damaged bone or cartilage and removes inflamed or damaged tissues. After that, a doctor closes the incision with stitches or small bandages and wraps the knee with a larger bandage or dressing.
• Knee ligament repair: Knee ligament repair is an outpatient procedure. In this procedure, a surgeon replaces the ligament with a piece of healthy tendon. This procedure is performed under the influence of anesthesia. The recovery period for knee ligament repair is quite short.

Different types of ACL surgery grafts are as follows:

• Bone-patellar tendon ACL graft: A bone-patellar tendon-bone graft is also known as a patellar tendon graft. It is a type of graft that is used during ACL reconstruction surgery. The graft is taken from the middle of the patient’s patellar tendon at the front of the knee, which connects the patella (kneecap) and tibia (shinbone). The graft usually consists of tendon tissue and small bone plugs at either end of the graft. One bone plug is derived from the inferior patella, and the other bone plug is harvested from the tibial tubercle. A doctor usually places the graft in the same anatomical footprint as the original ACL and secures it in place with special surgical screws. The patellar tendon graft is usually utilized because it is a strong graft that heals quickly and has demonstrated proven durability in high-demand athletes. They are primarily used in adults and are usually not recommended for children (skeletally immature) whose bones are still growing.
• Quadriceps tendon ACL reconstruction graft: Quadriceps tendon grafts are a relatively new graft used in the treatment of ACL tears. This graft uses tissue from the central distal quadriceps tendon. Similar to patellar tendon transplants, quadriceps tendon grafts are implanted in the same anatomic region as the ACL and can be made with or without a single bone plug. Patients who have a history of patellar tendonitis or patients who do not have a patellar tendon can be used as a graft source.
• Hamstring tendon ACL graft: It is another option to repair or reconstruct a torn anterior cruciate ligament (ACL). There are 4 hamstring muscle-tendon units. Two of these hamstring tendons (gracilis and semitendinosus) attach to the anterior tibia just below the knee. These two tendons can be easily harvested through a small incision and combined to make a well-sized ACL graft. Minimal effects on hamstring strength and performance are typically observed after the harvest of these two tendon. Hamstring grafts are usually recommended for patients who may be involved in activities that require frequent crawling, squatting or kneeling. As the use of patellar grafts can sometimes cause pain at the front of the knee, the use of hamstring grafts for ACL surgery is not associated with this side effect. Hamstring tendon-based ACL reconstruction is a patient-friendly, low-morbidity option.
• Allograft ACL reconstruction graft: An allograft is a type of graft that is donated to a tissue bank by a donor. These grafts, much like the grafts mentioned previously and can be harvested from many different anatomic locations. Patellar tendon grafts, quadriceps tendon grafts, and hamstring tendon grafts can be obtained through allograft sources. Allograft tissue is the ideal choice for patients who have experienced multiple ligament knee injuries. Donor tissues are a safe option for ACL reconstruction surgery. These tissues are tested, sterilized, and processed before they are accepted for use by tissue banks. Part of this processing includes removing any blood, cells or other living components on the tendon graft. It helps to decrease the possibility of tissue rejection after surgery.

Strong tissue bands called ligaments join one bone to another. The ACL connects the thighbone to the shinbone and aids in stabilizing the knee joint. It is one of two ligaments that cross in the center of the knee. ACL injury usually occurs during sports and fitness activities that can put stress on the knee. Some of the common reasons for ACL injury are as follows:

• Suddenly slowing down and changing direction (cutting)
• Pivoting with your foot firmly planted
• Landing on one leg, such as when jumping in volleyball or basketball
• When the knee is bent backward or twisted, which can occur during a fall or landing a jump awkwardly
• Through repeated stress to the knee, which can cause the ligament to lose elasticity
• Overextending your knee joint
• Receiving a direct blow to the knee or having a collision, such as a football tackle

If you are looking for the best surgeon for ACL surgery, then you must consider the following factors before choosing one:

• Experience and expertise of the surgeon: It is one of the important aspects to consider before choosing an orthopedic surgeon for ACL reconstruction surgery. Orthopedic surgeons deal with some serious medical conditions, so it's important to visit one who has a solid track record of success.
• Patient testimonials: Before choosing a surgeon, look into the patient's review and medical history. It gives you an idea about the surgeon's professionalism, bedside manner, and communication abilities. In essence, In short, it gives you a rough idea about the quality of care along with the success rate.
• Surgeon’s credentials: Verify the surgeon's credentials and area of expertise. Ensure that the surgeon is up to date in his/her knowledge and doesn't have any major issues/complications in performing any treatment or surgery. Moreover, it also gives you an idea about the experience and expertise of the surgeon.
• Consider location and convenience: To prevent any issues during the treatment procedure, consider a surgeon who is within a fair driving distance. In addition to providing great care, an orthopedic surgeon must be immediately reachable or readily available, especially in emergency situations.
• Research about the hospital: Doing your research about the hospital is one of the key things to do before choosing a surgeon. Look into the hospital where your orthopedic surgeon practices. It provides information on the medical team, hygiene, and the quality of service they offer. Before choosing a surgeon, we advise you to check patient reviews and recovery rates.

Arthroscopic ACL reconstruction surgery involves a number of steps, including

• Incision: Surgery begins with making a small incision around the knee joint, creating portals of entry for the arthroscope and other surgical instruments.
• Arthroscope insertion: A surgeon inserts the arthroscope in the knee and injects saline solution to expand the space around the joint. It helps in making space for surgical tools, including an arthroscopic camera that sends video to a monitor so that the surgeon can see inside the knee joint.
• Evaluation: A surgeon then evaluates structures that surround the torn ACL, including the left and right meniscus and the articular cartilage. The surgeon treats any lesions in these soft tissues if they exist.
• Harvesting of graft: After that, a surgeon harvests the grafts. A section of tendon from another part of the patient’s body is cut to create a graft, which is then attached at each end to plugs of bone taken from the patella and tibia. These plugs help in anchoring the graft that becomes the new ACL. The surgeon inserts the new ACL into the femur and tibia using a flexible guide wire. Screws are used to secure the plugs of bone. With time, these plugs grow into the surrounding bone. After surgery, all the surgical instruments are removed.

There are various factors that can affect the cost of ACL reconstruction surgery, including

• Type of anesthesia administered
• The city of the treatment
• The general cost of hospitalization
• General fees of the surgeon
• Comorbidities such as diabetes, liver or lung disease, etc.
• Type of graft used
• Additional surgery
• Rehabilitation and physiotherapy
• Insurance coverage
• Severity of the condition
• Any pre-existing health condition

• 1-month recovery: The initial first after surgery is the most crucial for healing time. Be rigorous toward good nutritional intake and the use of ice to control excessive inflammation. During this phase, the body is healing from surgery and requires an optimal environment to ensure the readiness of the muscles to make necessary strength gains. It is extremely important to regain control of the leg muscles, especially the quadriceps (thigh) muscle, to achieve normal gait and improve strength. Strength regaining is quite helpful for activities like stair climbing and standing from a seated position. Improving mobility of the knee is also important to improve function and serves a secondary purpose for healing. It also helps in distributing vital nutrients to the healing tissues.
• 2-month recovery: In 2 months of recovery, remodeling of the tendon replacement, or graft, occurs. If an individual uses their own tendon as a replacement for the torn anterior cruciate ligament, then the tendon must undergo remodeling. During remodeling, the tendon breaks down (or remodels) into ligamentous tissue suitable to withstand the forces required of an ACL. By the end of this recovery period, patients note a significant improvement in recovery. If no other structures were repaired in addition to the ACL, many patients may be able to walk without an assistive device or brace. Due to decreased inflammation, they may also regain satisfactory mobility to perform activities like bending the knee to put on pants and other physical activities.
• 3-month Recovery: In this phase, the knee is capable of taking greater loads, and individuals may note the considerable gains in functional strength. Patients begin working on more activity-specific strengthening and weight-bearing exercises, such as squats, ascending and descending stairs, and balancing. You can also begin biking with resistance. The muscles begin to recover their normal function, and gait becomes quite normalized. Diligence during this phase is critical as patients focus on building lower extremity strength, endurance, and control to enable progression to impact exercises in preparation for return to work, sport, or other activities during the next phase.

ACL reconstruction is a safe and effective surgery, and associated complications are rare. But like any surgical procedure, it also carries certain risks and complications, including

• Stiffness: It is a common post-ACL reconstruction complication and is defined as the incomplete range of motion of the knee following surgery. A poor surgical approach or a lack of adherence to the post-operative rehabilitation plan is one of the reasons for stiffness. Knee stiffness can be treated with aggressive rehabilitation, manipulation under anesthesia, and arthroscopic adhesiolysis.
• Patella fracture: It is a rare complication and usually results from graft harvesting. The patella fracture may require surgical management.
• Chances of infection: Pain, swelling, redness, the rise in temperature, and stiffness may occur as a result of infection. The infection is usually managed with thorough lavage, antibiotics, debridement, etc. In some cases, it may necessitate the removal of the graft.
• Chances of pain: Post-surgery, there is a chance of pain in the front of the knee, which is commonly associated with a patellar tendon graft. It may also occur in cases of allograft and quadriceps tendon graft. Put ice or a cold pack on your knee to manage the pain.

Most insurance companies in India cover the cost of ACL tear surgery because it is a medically necessary procedure that is typically performed to help individuals regain stability, function, and mobility in their knee joints. ACL injuries are common among athletes and active individuals and can occur due to sudden twisting or impact on the knee.

The coverage may vary depending on the specific insurance plan and the individual’s medical history and needs. It is crucial to speak with your insurance provider to understand more about the benefits of your plan and any potential out-of-pocket costs you may incur.