Anterior cruciate ligament (ACL)

Get the Best Treatment for Anterior Cruciate Ligament

Three bones meet to form knee joint- Thigh bone (femur),Shinbone(tibia) and kneecap(patella).Kneecap sits in the front of the joint to provide some protection. Bones are connected to other bones by ligaments. There are four primary ligaments in the knee which act like strong ropes to hold the bones together and keep the knee stable.

Anterior cruciate ligament is one of a pair of cruciate ligaments the other being the posterior cruciate ligament in the knee. They are also called cruciform ligaments as they are arranged in crossed formation.

The anterior cruciate ligament is one of the four main ligaments of the knee and provides 85% of the restraining force to anterior tibial displacement at 30 degrees and 90 degrees of knee flexion. It is a strong ligament runs diagonally through the middle of the knee. It helps keep the knee stable especially during turn or when knee joint moves from side to side. If ACL is torn your knee may become very unstable and lose its full range of movement. This can make it difficult to perform certain movements such as turning on the spot. Some sports may be impossible to play,


Causes for Anterior Cruciate Ligament Injury:

Knee injuries can occur during sports such as skiing, tennis, squash,football and rugby. ACL injuries are one of the most common types of knee injuries accounting for around 40% of all sports injuries.

  • Changing direction rapidly
  • Slowing down while running
  • Stopping suddenly
  • Landing from a jump incorrectly.
  • Direct contact or collision during football tackles.
  • It can also tear due to lower leg extends forwards too much. Also if knee and lower leg are twisted


Many studies have shown that female athletes have a higher incidence of ACL injury than male athletes due to difference in physical conditioning, muscular strength and neuromuscular control. Other suggested causes include pelvis and lower extremity (leg) alignment, increased looseness in ligaments and the effects of estrogens on ligament properties. Women tend to not activate their hamstring muscles as much as their male counterparts during certain cutting movements causing less stability in the knee joint. There is some evidence that suggests since women are known to have larger Q angles than their male counterparts thus they might be more susceptible to ACL tears.


Surgery/Transplants Procedure:

  • Anterior cruciate ligament surgery treatment is a complex surgery that requires expertise in the field of sports medicine.
  • Many factors should be considered when discussing surgery including the athlete's level of competition, age, previous knee injury, other injuries sustained, leg alignment and graft choice.
  • It involves rebuilding the ligament
  • Most ACL tears cannot be sutured (Stitched) back together. To surgically repair the ACL and restore knee stability the ligament must be reconstructed.
  • The doctor will replace your torn ligament with a tissue graft and this graft acts as scaffolding for a new ligament to grow on.
  • Grafts can be obtained from several sources. Often they are taken from pellar tendon which runs between the kneecap and the shinbone.Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon which runs from the kneecap into the thigh is used. Finally, cadaver graft(allograft)can be used.
  • There are advantages and disadvantages to all graft sources. You can discuss the graft choices with the orthopaedic surgeon to help determine which is best for you.
  • Because the regrowth takes time it may be six months or more before an athlete can return to sports after surgery



  • You will either have a general anaesthetic which means you will be totally unconscious during the procedure or a spinal anaesthetic, where anaesthetic is injected into your spine so that you are conscious but unable to feel pain.
  • Surgery to rebuild an anterior cruciate ligament tear treatment is done with an arthroscope using small incisions.
  • Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital and quicker recovery times.
  • The operation will take one to one and a half hours and will usually require an overnight stay in the hospital


ACL can be treated non operatively with strengthening and rehabilitation and occasionally injections when the ACL is not completely torn and the knee is still stable or if the patient is not doing activities requiring cutting and pivoting or similar actions. Anterior reconstruction surgery India is provided with qualified and good doctors and successfully.


Final Examination:
Once the graft tissue has been secured, your surgeon will test that there is enough tension in it.

They will also check that your knee has the full range of motion and that the graft keeps your knee stable when its bent or moved When the surgeon is satisfied with everything working properly they will use stitches to close the incisions and apply dressings.
After the procedure you will be moved to a hospital ward to begin your recovery


Recovery From The Surgery:

Anterior cruciate ligament surgery recovery can take up to an year.
After knee surgery the wound would be closed with stitches or surgical clips. If the stitches are dissolvable, they should disappear after about three weeks. If your stitches aren’t dissolvable they will need to be removed by a healthcare professional. Your surgeon will advise you about this. They will also tell you the guidelines to take care of your wound.

Washing with a mild soap and warm water is usually all that is required.

You will be bandages and may also be given Cryo/Cuff to wear which is a waterproof bandage that contains iced water to help reduce swelling. You may also be given pain killers. Painful bruising, swelling and redness down the front of your shin and ankle. This is caused by fluid inside your knee joint leaking down your shin. These symptoms are temporary and will start to improve after about a week.



As with all types of surgery there are some risks associated with knee surgery. They are

  • Infection- The risk of infection is small (1%)an antibiotic may be given after operation to prevent infection developing.
  • Blood clot-The risk of blood clot forming and causing problems is very low about 1 in 1000.If you are thought to be at risk, you may be given medication to prevent blood clots forming.
  • Knee pain- Affects almost 2 in 10 people who have ACL surgery and is more likely to occur when the patellar tendon is used as graft tissue, you may have pain behind your kneecap or when kneeling down or crouching.
  • Knee weakness and stiffness-Some people experience long term weakness or stiffness in their knee.
  • After ACL surgery there is also a small chance that the newly grafted ligament will fail and your knee will be unstable.
  • If the first operation is unsuccessful further surgery may be recommended.

However, subsequent operations are often more difficult and don't usually have the same long term success rate as a first tendon repair.


Anterior cruciate ligament rehabilitation:

Whether the treatment involves surgery or not rehabilitation plays a vital role in getting the knee back to daily activities. Physical program will help regain strength and motion. If you have surgery physical therapy first focuses on returning motion to the joint and surrounding muscles which is followed by strengthening program designed to protect the new ligament. The strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete’s sport.


Your surgeon or physiotherapist can advise you about a structured rehabilitation programme. It is very important to follow the programme so the recovery is as successful as possible

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