"ACL injuries aren’t just an athlete’s problem. Anyone can suffer from them," says Dr. Manivannan, Consultant Orthopaedics, Arthroscopy, & Joint Replacement Surgeon at Kauvery Hospital, Salem. He recalls a memorable case: a woman who had undergone shoulder surgery at another hospital but continued to experience knee pain. Upon visiting Kauvery, she was diagnosed with a missed ACL tear. After undergoing ACL reconstruction, she made a remarkable recovery and is now fully active. This underscores the importance of accurate diagnosis and timely intervention for ACL injuries.
ACL tears are commonly associated with high-impact sports like football, basketball, and long jump. These activities often involve sudden pivoting movements, which put significant stress on the knee joint. However, sport is not the only culprit. Non-athletes can experience ACL tears due to road traffic accidents, slips, or even while engaging in playful activities at the beach, where turbulent water can strike the knees unexpectedly.
Obesity, while not a direct cause, is another factor. People with poor muscle control, often seen in those with higher body fat, are at greater risk. Weak quadriceps muscles can lead to instability, making the knee more vulnerable to injuries during everyday activities.
Diagnosis begins with a detailed patient history and physical examination. Patients often report knee instability, a sensation of their knee 'giving way,' or even hearing a popping sound at the time of injury. These are key indicators of an ACL tear.
Once the clinical examination points toward an ACL injury, doctors use MRI scans to confirm the diagnosis and assess the extent of the tear. This combination of clinical and imaging tools ensures a comprehensive evaluation, guiding the appropriate course of treatment.
The treatment for ACL tears depends on several factors, including the patient’s age, activity level, and the severity of the injury. For active individuals—especially those under 50—surgery is often the best option. Arthroscopic ACL reconstruction has become the gold standard. This minimally invasive procedure involves replacing the torn ligament with a graft, which can be an autograft (from the patient’s own tissue) or, in some advanced centers, an allograft (from a donor).
In recent years, synthetic grafts have also been introduced. Synthetic grafts eliminate the need to harvest tissue from the patient, potentially reducing surgical pain and shortening recovery time. However, these are typically reserved for patients with recurrent ACL injuries.
Non-surgical treatment is an option for partial tears or patients who lead less active lifestyles. In such cases, physiotherapy focused on strengthening the quadriceps and hamstring muscles can help stabilize the knee. Rehabilitation exercises improve joint function and may allow the patient to return to normal activities without surgery.
Arthroscopy, a minimally invasive surgical technique, has revolutionized the treatment of ACL injuries. Before the 1980s, ACL reconstruction required open surgery, which involved larger incisions and longer recovery times. Today, arthroscopy uses small incisions and a camera to guide the surgeon, making the procedure less painful and recovery much faster.
Dr. Manivannan highlights the versatility of arthroscopy, which can address a range of joint issues beyond ACL tears, including meniscus repairs and cartilage damage. Despite its widespread use in orthopedics, awareness of arthroscopy among the general public remains low. "Just as patients now ask if surgeries can be done laparoscopically, they should demand arthroscopy for joint problems," he emphasizes.
One of the most significant advancements in ACL treatment is the emphasis on individualized care. Every patient’s needs are different, and treatment plans are tailored accordingly. For example, athletes playing specific roles, like goalkeepers or wicketkeepers, require their knees to stay in a flexed position for extended periods. These patients benefit from specific graft types that can withstand repetitive stress.
Similarly, for individuals with more sedentary lifestyles or jobs that require prolonged kneeling, such as plumbers or those performing religious practices, treatment plans and graft choices are customized to ensure optimal recovery and function.
Recovery from ACL reconstruction typically takes six to nine months. The first phase involves gradual weight-bearing and focused physiotherapy to strengthen the knee muscles. For the initial few weeks, patients may need to avoid putting weight on the knee, depending on the type of graft used and whether additional procedures, like meniscus repair, were performed.
By the third month, most patients can start light activities such as cycling. However, a return to high-impact sports or physically demanding tasks may take up to nine months.
"Success depends on two critical factors: a precise surgical technique and a supervised rehabilitation program," says Dr. Manivannan. The role of the patient is equally important. A structured physiotherapy program ensures that the knee regains its full range of motion and strength. Patients who actively engage in their recovery process are more likely to achieve better outcomes.
An untreated ACL injury can have serious long-term consequences. The knee may become unstable, leading to further damage. "Without the ACL acting as a stabilizer, the bones in the knee can grind against each other, causing meniscus tears and early-onset arthritis," warns Dr. Manivannan. Patients may also experience difficulty in everyday tasks like walking, climbing stairs, or running.
Emerging technologies, such as synthetic grafts, hold promise for improving recovery times and reducing surgical pain. However, their adoption in India remains in its early stages. "In countries with advanced healthcare systems, synthetic grafts are primarily used for patients with multiple ACL injuries. As these techniques evolve, we may see broader use in India," says Dr. Manivannan.
ACL injuries, though challenging, are highly treatable with modern surgical techniques like arthroscopy. The key to successful recovery lies in personalized care, a rigorous rehabilitation program, and patient commitment. Whether you’re an athlete or someone dealing with an unexpected knee injury, early diagnosis and tailored treatment can help you regain your mobility and quality of life.
Consultant - Orthopaedics, Arthroscopy, & Joint Replacement Surgeon