ACL Reconstruction Surgery in Indore

Restoring a Stable Knee After Anterior Cruciate Ligament Tear – Arthroscopic Reconstruction and Structured Rehabilitation With Dr Murtuza Rassiwala

All of this happens in a flash. You swerve to the side on the football field, awkwardly land after a jump in basketball, or twist while falling off a two-wheeler – and you feel or hear a pop deep inside the knee. Within hours the knee will swell, and in subsequent weeks you may feel as though you cannot trust it when you turn. These are telltale signs of a tear in the anterior cruciate ligament (ACL).

Once completely torn, the ACL does not reliably heal. Individuals who want to return to sports involving turning and jumping or have repeated episodes of the knee giving way in everyday activities may choose an ACL reconstruction, which replaces the torn ligament with a new graft. Dr. Murtuza Rassiwala, an arthroscopic and orthopedic surgeon in Indore, who performs ACL reconstruction using keyhole surgery, supports each patient through the months of rehabilitation that will decide the final result.

Not all ACL tears need surgery. Part of the consultation is to see if reconstruction or a structured rehabilitation program is right for your knee, your activities and your goals.
Short answer: ACL reconstruction is an arthroscopic procedure in which a torn anterior cruciate ligament is replaced with a tendon graft, usually the patient’s own hamstring or patellar tendon. It is mainly recommended for active people and those who are having trouble with the knee giving way. The return to pivoting sport generally takes around 9-12 months of structured rehabilitation.

ACL Reconstruction at a Glance

These timelines are typical ranges from sports medicine practice. Your progress will depend on any associated injuries, the graft used, your fitness and how well you adhere to rehabilitation.

What is the ACL?

The anterior cruciate ligament (ACL) is a strong band of tissue inside the knee that is about the thickness of a little finger. It runs diagonally from the back of the thigh bone (femur) to the front of the shin bone (tibia) crossing the posterior cruciate ligament – hence the name “cruciate” (cross-shaped).

The ACL has two main functions. It prevents the shin bone from sliding forward under the thigh bone and controls twisting (rotational) movement of the knee. It’s this rotational control that allows you to cut, pivot, decelerate and land jumps with confidence. Without a functioning ACL, movement and “giving way” of the knee is common during these activities, while walking in a straight line may not be as bad.

There are also nerve endings in the ACL that tell the brain where the knee is. After a tear, many people find that their knee doesn’t feel as secure, even before a definitive episode of giving way.

How Does an ACL Tear Happen?

The majority of ACL injuries occur without contact with another player, worldwide. The mechanisms typically are:

• Sudden change of direction with foot planted – common in football, kabaddi, basketball and badminton.
• Landing from a jump with a straight knee or rolling inward.
• Running with rapid deceleration.
• Hyperextension – bending the knee backward beyond straight.
• Direct blows to the side or front of the knee by tackles or accidents.
• Twisting falls from two wheeler, on stairs or on wet flooring.

In India, ACL tears are not only seen in competitive athletes but also in recreational athletes, gym-goers, dancers and people injured in road traffic accidents.

Who is More Likely to Tear the ACL?

Anyone can injure the ACL, but some groups are more at risk.

• Young Athletes in Changing Sports: In sports like football, kabaddi, basketball, handball and badminton, we see many ACL tears in teenagers and young adults. These sports are a mix of speed, sudden stops and quick changes of direction.
• Women athletes: Sports medicine research has repeatedly documented that female athletes have a higher rate of non-contact ACL injury than male athletes in the same sports. Differences in landing mechanics, muscle activation patterns, anatomy and hormonal factors have all been examined. Structured neuromuscular warm-up programs can decrease this risk.
• Recreational and Weekend Players: The adult who plays hard once or twice a week without regular conditioning – as in corporate football or box cricket – may not have the muscle strength and control to guard the knee during sudden movements.
• Individuals With a Prior ACL Injury: Following a tear of one ACL, the likelihood of injuring the reconstructed graft or the ACL in the contralateral knee is increased, particularly in the first couple of years following return to sport.

Symptoms of an ACL Tear

At the Time of Injury

• A popping or tearing feeling in the knee.
• Pain is immediate, often severe enough to stop play.
• Quickly increasing swelling within a few hours due to bleeding into the joint.
• Difficulty bearing weight on it or fully extending the knee.

Days and Weeks Afterward

Most patients are surprised to find that once the initial pain and swelling have gone, they actually feel better and are able to walk normally again. This can be deceptive. The main long-term symptom is instability – the knee giving way or shifting when you turn, twist, awkwardly step off a kerb or play sport. Each episode may result in more swelling and pain on giving way.

Signs of related damage

Locking, catching or pain localized over the inner or outer joint line may suggest a concomitant meniscus tear. Pain on the inside of the knee may indicate MCL involvement. The plan for treatment is influenced by concurrent injuries.

Associated Injuries – Why a Thorough Assessment Matters

ACL tears are rarely a stand-alone injury. The same forces that can tear the ligament can also injure:

• The menisci, especially the lateral meniscus at the time of injury and the medial meniscus with repeated episodes of instability.
• The articular cartilage that may be bruised or damaged when the bones move.
• The MCL is often injured along with the ACL.
• The posterolateral corner structures on the outer back of the knee that can cause a reconstruction to fail if missed.
• Bone when the knee movement causes characteristic bone bruises seen on MRI.
  If these injuries are identified before the operation, they can be treated at the same operation if appropriate.

How an ACL Tear is Diagnosed

Clinical History The injury story is often very suggestive: a non-contact twisting injury, a pop, rapid swelling and inability to continue playing strongly indicate an ACL tear.
Examination: Dr Rassiwala will examine the knee for swelling, range of movement and tenderness and perform specific tests. The Lachman test involves pulling the shin bone forward gently with the knee slightly bent, and comparing the movement and “end-feel” to the other knee. The anterior drawer test is performed with the knee in greater flexion. The pivot-shift test reproduces the rotational laxity of the ACL-deficient knee and is often easier to perform after pain subsides or under anesthesia. The menisci, collateral ligaments, and PCL are also examined.
X-Rays: X-ray rules out fractures (including a small avulsion fragment on the lateral aspect of the tibia (Segond fracture) which is highly associated with ACL tears).
MRI: MRI confirmed the ACL tear and showed associated meniscus, cartilage and ligament injuries, and bone bruising patterns. The scan is an important planning tool for surgery but the decision to operate is based on the whole clinical picture not just the scan.

Partial Versus Complete ACL Tears

Not every ACL injury is a complete tear. Some partial tears still leave enough ligament intact to keep the knee stable, especially for people with lower activity demands. These types of tears are often treated with physiotherapy and a gradual return to activity. Reconstruction is typically considered for a complete tear in an active patient or for a partial tear that leads to instability. Clinical examination is particularly important in differentiating these situations because MRI reports can overestimate or underestimate the degree of tearing.

Do you need an ACL surgery?

There isn’t a universally applicable answer. Several factors dictate the choice:

Why You Often Hear About Reconstruction

• You want to get back to sports which involve pivoting, cutting or jumping like football, kabaddi, basketball, badminton or cricket fielding.
• Your knee continues to give out during daily activities, even with rehab.
• Repairable meniscus tear that is going to heal better with a stable knee.
• Other ligaments are also torn.
• Your job requires a stable knee, e.g. armed forces, police, physical training or some manual jobs.
• You are young and active, as repeated instability over years can damage the menisci and the cartilage.

Circumstances in Which Non-Surgical Care Might Be Justifiable

• Your knee is stable during daily activities and you are willing to not change sports.
• The tear is only partial and the knee is still functionally stable.
• You don’t do much activity or have health problems that make surgery riskier.

Some patients will start with rehabilitation and then opt for reconstruction if instability persists. This is a valid approach if the knee is monitored so that repeated giving-way episodes do not damage other structures.

Non-Surgical Treatment of ACL Injuries

Non-operative management is an active program and not just rest and wait.

• Early Phase: Ice, compression, elevation, crutches if needed, and gentle exercises to restore full straightening and bending as the swelling goes down.
• Strengthening Phase: Gradual strengthening of hamstrings, quadriceps, hips and core muscles. The hamstrings, in particular, act to stop the shin bone moving forwards.
• Neuromuscular Training: Exercises that emphasize balance, proprioception, and movement-control teach the knee to remain stable during more challenging tasks.
• Activity Adjustment: Participation in lower impact pivot sports reduces the likelihood of giving-way episodes. Some patients may use a functional brace for certain activities. A brace does not replace the ligament.

If the knee continues to give way following this program, then reconstruction is usually advised to protect the meniscus and cartilage.

Living With an ACL-Deficient Knee

Some patients postpone or refuse surgery. Knowing what this means in practice helps you make an informed choice.
Often achievable are activities that are performed in a straight line such as walking, cycling, swimming with a straight-leg kick and gym work on machines. Sudden turns, uneven ground, awkward stepping off busses or kerbs and sports with cutting tend to be where problems happen. Each giving-way episode can extend other tissues and tear the meniscus. If you choose non-surgical management, regular reviews are worthwhile and any new locking, persistent swelling or repeated giving way should be reported promptly, as these may suggest further damage that alters the recommendation.

Meniscus Treatment at the Time of ACL Reconstruction

Meniscus tears are common after ACL reconstruction surgery in the knee. It is common and important to treat them in the same operation.

• Repair of Meniscus: If the tear is in the outer, well vascularized part of the meniscus, and the quality of the tissue is good, the tear can be sutured with all-inside or other suturing techniques. The new ACL graft provides a stable environment which increases the likelihood of successful healing of the repair. Meniscus repair is generally a little more cautious early rehab with some limitations on deep bending and sometimes weight bearing for a few weeks.
• Partial Meniscectomy: In the inner zone, tears with tears of complex degenerative tissue or tissue that is not amenable to repair may be debrided back to a stable rim, removing only the torn portion.
• Root Tears and Ramp Lesions: Meniscus tears at the back of the knee or at the root attachment can go unnoticed and have a huge impact on knee mechanics. These are looked for during arthroscopy and carefully repaired when appropriate.

Revision ACL Surgery

Sometimes a reconstructed ACL fails due to a new injury, tunnel position, unrecognized associated instability, graft healing problems or infection. Revision ACL reconstruction is more complex than primary surgery. This may include removal of old implants, bone grafting of widened tunnels before a second-stage reconstruction, a different graft source and treatment of other injured structures. Detailed imaging (often CT) may help to plan revision surgery. Patients should anticipate a longer, sometimes more cautious recovery.

The Timing of ACL Reconstruction

Performing the operation when the knee is still swollen, stiff and inflamed can increase the risk of stiffness afterward. So many surgeons prefer to wait until the swelling is down, the knee is straight, the bending is back to a great extent and the thigh muscles can be well activated – often a few weeks after injury. The time of “prehabilitation” is well used to prepare the knee.

If there is a meniscus tear that has been displaced and is locking the knee, or if other injuries require urgent treatment, surgery may be performed sooner. Delays in reconstruction for many months or years in an unstable, active knee increase the risk of further meniscus and cartilage damage.

Graft Options for ACL Reconstruction

The new ligament is created from a graft. Each option has advantages and considerations, and the choice is individualised.

The choice is influenced by your age, sport, occupation (for example jobs that require frequent kneeling), previous surgery on the knee, associated ligament injuries and your own preference after discussion.

How ACL Reconstruction Is Performed

• Preparation and Anesthesia: After tests before operation and your acceptance you are taken to the operating theater. Spinal anesthesia numbs the lower body. A nerve block may be added for pain control. Examination of the knee under anesthesia confirms the degree of instability.
• Diagnostic Arthroscopies: Little portals are formed on the front of the knee. The arthroscope is introduced to visualize the ACL remnant, menisci, cartilage and other structures. Associated injuries are managed at this stage – meniscus tears are repaired where possible or trimmed if not repairable.
• Harvest and Preparation of Graft: The selected graft is harvested through a small incision and prepared on a side table to the appropriate length and thickness.
• Tunnel Building: Drill accurate tunnels in the femur and the tibia where the ACL was attached. Proper tunnel placement is one of the most important technical factors in reproducing normal knee mechanics.
• Graft Insertion and Fixation The graft is threaded through the tunnels and secured at both ends by means of devices such as suspensory buttons, interference screws or other fixation methods. The knee is moved through the range to assess graft tension, stability and freedom from impingement.
• Supplemental Procedures: In selected patients with high rotational instability, a lateral approach may be considered to improve rotational control. Other ligament injuries may be treated at the same time, where appropriate.
• Closure: The portals and incision for the graft harvest are closed. A dressing and sometimes a brace are applied.

Technology Used in ACL Reconstruction
Arthroscopic ACL surgery is based on high-definition camera systems, specialized guides for tunnel placement, and modern graft fixation implants. [Please check before you go to press – the exact equipment and implant systems used.] Technology can assist with accuracy but careful planning, surgical judgment and rehabilitation remain the most important factors in achieving a good result.

Advantages of ACL Reconstruction

• Restores knee stability during pivoting and turning.
• A large number of patients who complete rehabilitation are able to return to sport.
• Prevents further damage to the menisci and cartilage from repeated giving-way episodes.
• Provides a stable environment for healing of a meniscus repair.
• Builds confidence in your knee for everyday activities, work and sport.

Reconstruction does not put the knee back to exactly what it was before the injury and it does not remove the long-term risk of arthritis which is determined by the original injury and associated damage.

Preparing for ACL Surgery

• Make sure your knee can straighten and bend well before the operation.
• The physiotherapist aims to activate and strengthen the quadriceps.
• Learn to use crutches and practice your early post-operative exercises.
• Medical examination and blood tests.
• Optimize any medical condition and cease smoking.
• Transport home and assistance for the first week.
• Plan leave from work or study.

Hospital Stay

Most patients are admitted for a short stay, usually one to two days, to manage pain, check the wound and start exercises. Before you go home, you will be taught how to use crutches, how to stand and sit safely and how to activate the thigh muscles.

Recovery and Rehabilitation After ACL Reconstruction

Recovery from an ACL injury is a long and staged process. It’s not just the calendar, but criteria that define when you move forward.

Why it takes so long to return to sport

The graft undergoes a biological process of incorporation and remodeling, during which it is temporarily weaker. Studies have shown that returning to pivoting sports too early before strength and movement control have returned is associated with an increased risk of re-injury.

Post-Operative Care at Home

• Keep wound clean and dry. Follow instructions for dressings, bathing.
• Use ice and elevation to control swelling.
• Take pain medicines and any prescribed medicines to prevent clots as directed.
• Focus on straightening the knee fully – don’t put a pillow under the knee.
• Go to physiotherapy regularly and do your home exercises daily.
• Call the clinic for fever, increased redness or discharge, sudden increase in swelling or calf pain and swelling.

The First Two Weeks at Home – What Patients Commonly Experience

The first few days after ACL reconstruction can be a little tough. It is less worrisome knowing what is normal.

Days 1-3
The knee is swollen and tender, and the thigh muscles may not want to fire. The priorities are regular icing, elevation with the leg straight, ankle pumps and quadriceps tightening exercises. It’s good to move around the house on crutches, but not to stand for long periods.
Days 4-7
The pain usually starts to get better and bending gets better gradually. Bruising can run down to the shin or ankle, particularly after hamstring graft harvest. This is common and usually settles. Showering is done per wound instructions, frequently with waterproof dressings.
Days 8-14
Many patients find it easier to walk with crutches and may start to wean themselves off of them as directed. It’s usually at this point that stitches or clips are checked or removed. An important goal is to keep the knee fully extended.
Signs to Report Promptly
If you develop a fever, spreading redness around the wound, pus-like discharge, a sudden large increase in swelling or pain and swelling in the calf, you must report to the clinic immediately.

Nutrition, Sleep and Lifestyle During Recovery

Good overall health is necessary to repair tissue and rebuild muscle. A well-rounded diet with adequate protein intake from sources such as dal, paneer, eggs, curd, fish or chicken helps in muscle recovery. Healing is aided by staying hydrated, sleeping well and not smoking. Avoid drinking alcohol while taking strong painkillers. Keeping the body weight stable during months of inactivity also protects the knee. Special dietary needs or medical conditions: see your physician. Mental Training & Confidence Sport is not just physical in terms of returning.

Mental Readiness and Confidence

Athletes fear of re-injury, don’t want to cut and are frustrated by the length of rehabilitation. These are common feelings in recovery. You build confidence by hitting milestones, getting training with a physiotherapist or coach and slowly introducing the knee to sport-specific movements. You’re connected to better outcomes when you come back when you feel ready mentally and feel strong physically.

Prevention of ACL Injuries

Research has shown that injury prevention programs that include warm-up, strengthening, balance, plyometric and landing-technique exercises can reduce the incidence of ACL injuries in athletes. Key habits include a soft landing with bent knees and hips, knees over the feet not collapsing inward, hamstring and hip muscle strengthening, and not playing through fatigue. The coaches of school, college and club teams in Indore can include these drills in their regular training sessions and individual players can use them as a 10-15 minute warm-up routine before each match or practice session.

Returning to Work, Driving and Study

• Students and desk based workers: Usually 2 – 3 weeks depending on travel and comfort.
• Standing or walking jobs: generally 6–8 weeks.
• Heavy manual or physical demanding work: often 3-6 months.
• Driving: left knee in automatic car can sometimes be within a few weeks, right knee usually around 6 weeks – when you can brake safely and are off strong painkillers.
• Two-wheeler riding: as advised by your surgeon, when balance, strength and full control of the knee allows.

Return to Sport and Preventing Re-Injury

The best way to think about returning to sport is that it is a continuum, not a single day. You first return to training, then modified participation, then full competition and then your previous level of performance. You move to the next step only when the previous step is comfortable and in control.

Gradual progress from training to full competition is the return to sport. Prior to clearance, patients are typically evaluated on:

• Full range of motion without swelling.
• Thigh muscle strength on the uninjured side.
• Good symmetry on hops and agility tests.
  Confident, controlled landing and cutting mechanics.
• Psychological readiness and knee confidence.

Continuing an injury-prevention program – including neuromuscular warm-ups, landing technique and strengthening – when returning to sport helps protect both knees.

Common Misconceptions About ACL Tears

“I can walk, so my ACL is fine.”
Many people can walk fairly well within days of a complete ACL tear. The ligament’s main role is in controlling twisting and rapid changes in direction, so problems only tend to show when you turn, pivot or go back to sport.

“The MRI shows a tear, so I need surgery.”
The MRI is used to confirm the anatomy but the decision to operate depends on symptoms, instability, other injuries and your goals. Some people do well without a reconstruction.

“The only thing that will fix my knee is surgery.”
The operation creates a new ligament but it takes months of rehabilitation to get back the strength, control and confidence to play sport. A common cause for an unsatisfactory result is not undergoing rehabilitation.

“When I’m feeling better, I can start playing again.”
Just because you can do daily activities at three or four months does not mean the graft and the muscles are ready for competitive sport. Objective testing is a safer guide than the way the knee feels.

“The ligament is replaceable by a knee brace.”
While a brace can provide some support and confidence, it cannot duplicate the ACL’s control of rotation during high-speed movements.

Cost of ACL Reconstruction in Indore

The cost depends on many factors:

• The type of graft and fixation implants used.
• Indications for meniscus repair or other procedures.
• The hospital and the kind of room.
• Hospital length of stay.
  • Pre operative work up and MRI.
  • Physiotherapy and splinting after surgery.

We then provide you with a detailed estimate.

Insurance and Cashless Treatment

Health insurance policies generally cover ACL reconstruction for injury, subject to conditions, sub-limits and waiting periods of policy. Some policies have special conditions relating to sports injuries. Check your policy and cashless tie-ups of the hospital beforehand.

Questions to Ask Before Having ACL Surgery

It is helpful to get clarity before you sign up for reconstruction:

• Have I torn my ACL completely? Have I injured my meniscus, cartilage or other ligaments?
• Should I first have a period of rehabilitation in my case?
• What kind of graft do you suggest for me and why?
• Will you repair or trim any meniscus tear, and how will that affect my recovery?
• How long will I be on crutches and when can I return to college/work?
• What stages do I need to reach before I play sport and before I run?
• How can I reduce the risk of injuring either knee in the future?

Understanding this allows you to plan your study, work and family commitments around a recovery that really takes months.

Dr. Murtuza Rassiwala’s Expertise in Ligament Surgery

Dr Rassiwala is an arthroscopic and orthopedic surgeon in Indore. He completed his MBBS from Baroda University (2013), DNB in Orthopedics from the National Board of Examinations (2018) and MNAMS and fellowships as F.I.A.S.M. and F.I.A.J.R. His primary area of practice at Hakimi Ortho Care is arthroscopic knee surgery, including ligament reconstruction.

Why Dr. Rassiwala is the Right Choice for ACL Reconstruction

• Full knee assessment – associated meniscus, cartilage and ligament injuries are identified and planned for.
• Choice of graft based on your sport, work and knee.
• Fair and balanced advice – non-surgical rehabilitation is only discussed where it is really appropriate.
• Rehabilitation guidance, from prehabilitation to return to sport testing
• Follow-up available in two clinics in Indore.

Schedule ACL Consultation

If your knee is injured and feels unstable, swollen or unreliable, an early examination can determine if the ACL is torn and if other structures are involved. Please bring your MRI images and reports.

Call +91-7224888071, 0731-4981538 or 0731-3695285 or Book Online.

Medically reviewed by: Dr. Murtuza Rassiwala, MBBS, DNB (Orthopaedics)