Type of ACL Reconstruction
Selection of Graft
The surgical ACL reconstruction is done using grafts ,these grafts maybe
Autografts – when tendons are taken from patients own body
- 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 due to a few reasons –
- Likelihood of rupturing again is minimal
- Chances of secondary infection is less
- Hamstring tendon autograft has an added advantage that it regenerates over time making the graft more stable.
During the surgery
- Around the damaged knee 2-3 incisions are made by the surgeon.
- A thin tube fitted with a fibre optic camera (also called an arthroscope) is inserted through one of the incision. This allows the surgeon to see clearly inside the knee.
- Then the torn ACL is removed and the area is cleaned
- Through the other incisions 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 procedure if the surgeon feels that other ligaments, tendons, cartilage of the knee are also damaged then he may repair them.
- The incisions around the damaged knee are then closed with stitches or staples.
- Utmost care has to be taken to avoid infection so the incision area has to be kept dry and clean.
- A knee brace will be needed to be worn for 1-4 weeks
- Physical rehabilitation will be required to help gain back the stability and function of the knee joint which may take around 4-6 months.
Symptoms presented by patient of ACL Rupture are
- Many hear or feel a Pop in knee when ACL injury occurs. Even without the sound the damage can occur
- Severe Pain
- Swelling in the injured knee
- Loss of stability while walking and loss of motion range
Diagnosis and tests for ACL Reconstruction
For the success of the entire procedure it is important to have accurate diagnosis and knowledge of the severity and nature of the injury.
A thorough physical examination is conducted to understand the type of injury which has occurred. The doctor will assess the function of the knee joint by moving it in different positions.
Pivot shift test
The Pivot shift test is one of the main tests to understand ACL injury and the instability caused. If the test is positive a subluxation will occur at 20 to 40 degree of flexion which shows ACL damage.
Anterior drawer test
The anterior drawer test is used in the initial clinical assessment of the suspected Cruciate ligament rupture or integrity. The patient should be supine with the hip flexed at 45 degrees, the knees flexed to 90 degrees, hamstring relaxed and then pulled posterior to anterior direction. Excessive displacement of tibia anteriorly suggests that ACL has a potential tear.
This is another test performed by the orthopedician to diagnose rupture of anterior Cruciate ligament. The test is designed to assess single and sagittal plane instability. If the test is positive there will be increased forward/upward movement of tibia and a significant soft end point when this movement ends.
Medical Investigations For ACL Reconstruction
- X-ray to rule out a bone fracture
- MRI to show extent of injury and to enable evaluation of ACL injury and also to see if there is more damage to other knee ligaments, tendons
- An ultrasound may be used to see if there are any injuries in ligaments, tendons and muscles.
- Routine tests to declare you fit for surgery
Factors affecting the Cost of ACL Reconstruction surgery
Following are the factors which will affect the treatment cost:
- Hospitals in India provide ACL –reconstruction treatment at a cost that is comfortable for the patient and would come within his or her budget.
- The hospital the patient is opting for would be an important determinant of the total treatment cost.
- Category of the Room taken and number of nights – There are different prices for standard single room, deluxe room or a super deluxe room. This could also include 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.
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 arranged within a few weeks of surgery. There could also be rehabilitative therapy. Complete recovery will often take 4 to 6 months.