ACL Reconstruction Surgery: Types & Average Treatment Cost in India

A human body is filled with multiple cells and tissues and maintaining each of these is necessary to avoid health deterioration. The Anterior Cruciate Ligament (ACL) is an important soft-tissue structure in your knees. Any tear in this tissue calls for surgery, which is essential to avoid further complications.

An ACL reconstruction surgery will be mandatory if you have a partially or completely torn ACL. Find out more about this surgery in this article.

Knee muscles are essential for walking and moving. Therefore, it is advisable to avoid neglecting wear and tear in the muscles and tissues in the knees. The Anterior Cruciate Ligament is an important tissue in the knee connecting the femur to the tibia. It can get damaged because of stretches or tears. Athletes are likely to experience a complete tear of the ACL.

ACL surgery helps treat torn ligament in your knees by replacing it. The ligaments are beneficial for holding the bones of the knee together, keeping it stable. However, once it is damaged, you will no longer be able to stand on your knees, run or play sports.

You will require ACL reconstruction surgery if your ligaments tear and you face an injury. The common symptoms of such an injury are listed below. You must visit and seek medical help if you experience these.

• A loud pop sensation in your knees
• Knee swelling
• Severe pain
• Inability to walk or move due to knee pain
• Loss of motions
• A feeling of instability with weight bearing 

Once you visit a healthcare centre, doctors will likely conduct some tests to check if your ACL tear is complete or partial. These tests are listed below.

• Lachman Test: Doctors will try to pull your shin bone away from your thigh bone. If the tear is partial, the bones will have little to no movement.
• Pivot Shift Test: In this, patients lie on their backs while doctors place rotational pressure on their knees. The test shows partial tears if the bones do not move.

Now that you know what ACL reconstruction surgery is, you will better understand it by knowing its types. Doctors select the suitable type based on your condition.

1. Autograft

In this, surgeons use the patient's tissues from other body parts to replace the damaged ACL. These tissues are mainly taken from your knee, hamstring, or thigh.

Benefit:

• It is a safe and fast healing method. 

Survival Rate:

• 1 Year: 95%
• 5 Year: 90%

2. Allograft

Here, surgeons use tissues from a deceased donor to repair your damaged knee tissues. 

Benefit:

• It is often beneficial since it does not leave a second surgery site to heal in your body. 

Survival Rate:

• 2 Years: 95%
• 5 Years: 93%

3. Synthetic Graft

Surgeons use this method to replace the tendon with artificial materials. These materials included silver fibres and silk in the 20th century. However, currently, surgeons use more advanced options like carbon fibre and Teflon for this surgery.

Benefit:

It gives the advantage of getting rid of the possibility of disease transmission and donor-site morbidity with fast rehabilitation. 

Survival Rate:

• 1 Year: 95%
• 5 Years: 88%

An AL reconstruction surgery is a complicated one. It involves replacing the damaged ACL with a new one from a graft of replacement tissue from any of the following sources.

• A portion of your own hamstring, quadriceps or patellar tendon
• An allograft, considering tissues from other human organ donors

The type of graft depends on the case-by-case basis for each patient. Surgeons generally use minimally invasive arthroscopic techniques. It uses a combination of fibre optics, small incisions and small instruments. If there is a tissue graft, the incision will be larger.

You might have to start preparing in advance for ACL surgery by following these tips:

• Discuss your current medication and dietary supplements with the surgeon. If you take blood-thinning medicines, for instance, you might have to stop taking them for about a week before this surgery.
• Surgeons can make other recommendations on food and drinks before the surgery keeping your health and condition in mind. You will have to follow it without fail.
• Take care of yourself by quitting any negative habit like drinking or smoking.
• Plan ahead by redecorating your essentials in a way you can easily access them. Ask your relatives or friends to take care of you after the surgery. Buy crutch or similar equipment to use while recovering.

There can be some general risk factors associated with ACL surgeries. Here are a few common ones.

• Bleeding at the wound
• Pain in the surgery site
• Infection
• Blood clotting
• Shock
• Breathing trouble
• Trouble urinating
• Knee pain and stiffness
• Lack of fast healing

Usually, you might have to undergo several weeks of physical therapy before this surgery. The goal is to reduce the pain and swelling in your knees before even starting surgery to avoid complications. Previously, it has been seen that patients who enter a surgery with stiff and swollen knees take much longer to recover.

Now, when it comes to the steps for ACL reconstruction surgery, the process can be long and complicated. It starts with arthroscopy, moving on to graft harvesting. As this surgery is an outpatient (ambulatory) procedure, you can be discharged on the same day of the surgery. The steps for this procedure are as follows:

Step 1: Diagnostic Arthroscopy

Arthroscopic surgery allows the surgeons to insert tiny tools and a camera through a small cut they make around your affected knee. It causes less scarring than open-knee surgery. Surgeons conduct an arthroscopy to confirm the following in the initial stages.

• It helps to confirm that the surgeons have made a correct diagnosis from the pre-surgical tests.
• Surgeons can also get a better idea of the absence or presence of damages to other structures.
• It also helps to harvest the tissue graft from your body while matching the size and shape of your affected knee.

Step 2: Graft Harvesting

Your surgeons must decide if you should get an autograft to repair your ACL. They can then harvest the graft from a tendon in your kneecap, hamstring or front thigh. Then, they will cut at the harvest site and extract parts of the tendon to replace your damaged ACL. They can decide the amount of tissue to remove based on the following.

• Findings from the arthroscopy as in the previous step
• The severity of our injury and anatomy 

In another case, your surgeon might decide on an Allograft or synthetic graft. These will not require the surgeon to cut open any other part of your body.

Step 3: Reconstruction Surgery

This is the final step, where your surgeons will conduct the actual surgery. They will likely go through the following activities to reconstruct your damaged ACL.

• Surgeons will start with inspecting the remains of your native ACL, checking its attachment with the bones in your thighs and shins.
• They might put you on general anaesthesia. The procedure takes about an hour.
• They will then mark the areas on your thigh and shin bones for attaching the graft. Next, they drill holes or tunnels in these areas.
• They will likely attach a fastening suture to the tunnel on the shinbone and your thigh bone. It helps them to pull the tissues for your new ACL.
• The next step is to affix this new ACL to your thigh bone and hold it with a fastening device. They will then hold the other end of the graft and constantly bend and straighten the knee to avoid stretching.
• Finally, they might look into your knee's condition with arthroscopy to ensure the surgery was successful.

You might be able to go home on the same day of the surgery. However, doctors might suggest you take bed rest and avoid putting pressure on your knees.

Usually, surgeons allow patients to go home on the same day of the surgery. However, it would help if you learned about the recovery tactics before you leave. For instance, surgeons might suggest using crutches for the first few weeks or ask you to wear a knee brace or split to protect the graft. You will receive specific instructions on handling swelling and pain at the surgery site.

It will be essential to keep your leg elevated while applying a cold wrap or ice to your knee in the initial weeks. Moreover, doctors advise complete bed rest to avoid walking and putting excess pressure on the knees. You can use a cold wrap on your knee to avoid swelling and pain. Doctors might prevent you from bathing initially, and you will have to opt for dry sponging before you recover.

As ACL surgery is serious, you must learn the professional ways to dress your wound for a faster recovery. The medical team usually suggests patients rest the affected on pillows, put ice on it and then wrap it in a bandage to put compression on the wound. You might have to rely on crutches initially to avoid putting pressure on the knees while walking. Doctors might suggest the following to recover from this surgery.

• Over-the-counter drugs such as ibuprofen, acetaminophen, or naproxen
• Prescription drugs, such as meloxicam or gabapentin 

Usually, you might need 9-10 months to heal completely from an ACL surgery. Doctors suggest you return to your usual physical activities within a few months. However, there will be a restriction on those. Particularly, if you are an athlete, you cannot go back to playing sports before at least 12 months of rest and recovery.

There are no alternatives to ACL reconstruction surgery if the condition is severe and the ACL ligament is completely torn. However, for minor tears, you can follow non-surgical procedures like resting, applying ice, compression and elevating portions to help with pain and swelling.

ACL reconstruction surgery can be a significant financial investment, with costs varying based on factors such as the hospital, surgeon’s expertise, type of graft used (autograft vs. allograft), and post-surgical recovery. On average, ACL reconstruction surgery cost in India ranges from ₹2.5 lakh to ₹3.5 lakh. 

While the surgery itself is a one-time cost, the recovery process extends over several months, adding to the financial burden. The good news is that some health insurance policies cover the cost involved in ACL surgery, including the cost of hospitalisation, room, etc.

However, coverage can differ from policy to policy, and you must complete a specific waiting period under health insurance plans before the benefits apply. Therefore, it is always advisable to have health insurance in advance, which can help protect you from large surgery bills.