8 Questions To Ask Your Doctor Before ACL Surgery

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1. What are the different options of ACL surgeries available? Which one you recommend for me?

A. Primary ACL repair

During this procedure, damaged ACL is arthroscopically repaired to its footprint with help anchors. This procedure can be done only in fresh injuries. Chronic tears are not suitable for this procedure because ACL stump loses its healing potential as it gets old.

This procedure is suitable for
– ACL avulsion injuries.
– Sub synovial stretch injuries.
– Partial tears of ACL.
– Pediatric patients.

B. ACL Augmentation

ACL has 2 bundles, anteromedial bundle and posterolateral bundle. This procedure is done when only one bundle is torn and other is intact. Procedure is done arthroscopically using one hamstring graft. We recommend FiberTape augmentation with hamstring graft.

C. ACL Reconstruction

This is also an arthroscopic procedure, here ACL is reconstructed using
hamstring graft (most commonly used). There are plenty of methods in ACL reconstruction.
But we recommend ALL inside ACL reconstruction with FiberTape internal bracing using
single hamstring graft.

Advantages of ALL inside ACL reconstruction with FiberTape internal bracing

– Very minimal post-operative pain.
– post-operative knee bending – 90 degrees first day.
– Excellent stability if knee.
– Fast return to sports activity.
– Confidence level was achieved very early.

2. When will the physiotherapy process start?

With ALL inside ACL reconstruction with FiberTape internal bracing knee bending is started first day of the surgery. First postoperative day, you will be allowed to bend knee up to 90 degrees and allowed to walk using walker with weight bearing as tolerated. Physiotherapy will start immediately after the anesthetic has worn off. The patient will be able to go home the same day. Ice packs can be used to treat swelling. Physiotherapy will be essential to help and strengthen the musculature around the knee.

3. When can I to return to my work?

It depends on the nature of employment. For example, if the patient is having a sedentary style of job, the patient will be able to go back to work within a week following surgery. However, if the patient’s work involves walking and standing throughout the day, he will be able to return to work by 4 – 6 weeks. This restriction is to avoid pressure on operated joint and also allows patient to regain the confidence to walk independently.

4. Am I a good candidate for ACL reconstruction?

People who lead an active lifestyle, professional and recreational sports persons whose activity involve rotational and pivoting movements are good candidates for ACL surgery. This is beneficial particularly for people who have been through a physiotherapy and rehabilitation program but are still experiencing instability. This surgery can also benefit individuals who have injured more than one knee ligament.

5. Is ACL reconstruction the right option for every person?

Everyone does not need ACL reconstruction. People willing to make lifestyle changes and avoid the activities that cause recurrent instability can lead life without surgery. But people who wish to return to sports definitely need ACL reconstruction. Important prerequisite for nonoperative treatment is patient should not have recurrent instability. Other options like ACL repair and ACL augmentation can be used as explained earlier.

6. What are the risks associated with ACL reconstruction?

All surgeries are associated with risk. ACL surgery is also associated with its own risks. But these are very less as this surgery performed arthroscopically which does not need extensive incisions. We use regional anesthesia which is relatively very safe. Risks may include bleeding, knee pain or stiffness, reduced range of motion, wound healing problems and infection. But these are very rare. So, ACL reconstruction is relatively very safe surgery and no need to be afraid of the procedure.

7. What kind of an implant will be used during surgery?

ACL reconstruction is done arthroscopically using hamstring graft. We prefer ALL inside ACL reconstruction with FiberTape internal bracing. Here we recommend implants made by reputed international companies like Arthrex, stryker, conmed and smith and nephew. Arthrex, stryker, conmed are USA based implants, smith and nephew is UK based. All these companies have best quality implants. Femur side graft fixation is done with adjustable tight rope, graft internal bracing done with FiberTape, tibial side fixation done with tight rope loop, ABS button and swivel lock anchor.

8. What will happen if I delay my ACL surgery?

It depends on multiple factors like younger age, preinjury hours of sports participation, and amount of anterior instability. Younger the age more the chances of recurrent instability. Similarly, sports activities need stability of joint. If the person is already having instability, they always need surgery. If the surgery is not done on tine, femoral cartilage and meniscal damage will occur. After few years osteoarthritis with persistent knee pain will develop.