Knee
ACL Reconstruction
The anterior cruciate ligament stops the shin bone sliding forward and keeps the knee stable when you pivot. Once torn it does not heal back, so reconstruction replaces it with a graft, usually tendon taken from your own leg, threaded through tunnels in the bone and fixed in place.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
How the injury usually happens
The classic ACL tear happens without contact: planting a foot and turning, landing awkwardly from a jump, or a sudden change of direction. Football and cricket account for a large share of the sports injuries seen here. Many people hear or feel a pop, and the knee swells within a few hours.
Once the swelling settles, the knee can feel deceptively normal walking in a straight line. The trouble comes when you turn and it gives way. Each of those episodes can damage the meniscus and the joint surface, and this is one way a knee that was only ever unstable ends up with lasting knee pain. If you are young or active, it is the main reason not to live with it.
Do you always need surgery?
No. If your work and hobbies are straight-line (walking, cycling, treadmill, swimming), a torn ACL can often be managed with a structured strengthening programme and no operation at all.
Reconstruction is usually advised when:
- The knee gives way during ordinary activity, not just sport
- You want to return to a pivoting sport
- There is a meniscus tear that needs repairing at the same time
- Other ligaments were injured alongside the ACL
- Your job demands stability on uneven ground
What the operation involves
It is done arthroscopically, with a camera through small keyhole incisions, and takes about an hour to ninety minutes. The graft is taken, usually from the hamstring tendons. Tunnels are drilled through the shin bone and thigh bone where the ligament naturally attaches, and the graft is pulled through and fixed at both ends.
Most ACL surgery is done as a day case or with one overnight stay. If the meniscus is torn, it is repaired or trimmed in the same sitting. It is one more reason not to leave an unstable knee for years.
Dr. Ishan Khanna trained in knee and shoulder arthroscopy at Golden Clinics & Hospital, Chandigarh, and has research submitted on patient-reported outcomes after hybrid tibial fixation in soft-tissue grafted ACL reconstructions.
Recovery and getting back to sport
The operation is the short part. The rehabilitation is the treatment, and rushing it is the single most common reason a reconstruction fails.
- Week 0 to 2. Controlling swelling, getting the knee fully straight, and switching the quadriceps back on. Crutches for a short period.
- Week 2 to 6. Full range of movement, walking normally, static cycling.
- Week 6 to 12. Progressive strengthening, balance and control work.
- Month 3 to 6. Running in a straight line, then agility and gradual pivoting work.
- Month 9 to 12. Return to competitive pivoting sport, once strength and hop testing show the operated leg has caught up with the other one.
Going back at six months because the knee feels fine is how people re-tear grafts. Partway through that timeline the graft goes through a weak phase as it heals, and that is exactly when the knee starts to feel normal.
Risks
The main risk is re-tearing the graft, particularly if you go back to sport early. Others include stiffness or loss of full straightening, kneeling discomfort at the graft site, infection, blood clots, and some instability that remains. Numbness in a patch of skin below the incision is common and usually settles.
Common questions
How soon after the injury should surgery be done?
Usually not straight away. Operating on a hot, swollen, stiff knee raises the risk of stiffness afterwards. A few weeks of physiotherapy first, to settle the knee and get its movement back, generally gives a better result. The exception is a knee locked by a displaced meniscus tear, which is dealt with sooner.
Which graft is used?
Most often the hamstring tendons from the same leg. The choice depends on your sport, your build, whether this is a first or revision reconstruction, and what else is injured, and it is discussed before the operation.
Will I be able to play football again?
Most people who complete the rehabilitation return to their previous sport. The key word is complete. When you go back is decided by strength and control testing, not by the calendar alone.
Is a brace needed afterwards?
Sometimes, early on, particularly if the meniscus was repaired at the same time. Not everyone needs one; it depends on what was done inside the knee.
Not sure this is your problem?
These pages start from the symptom. They cover what else can cause it and what is usually tried first.
Not sure whether you need this?
Ask it at a consultation, and bring your imaging and any plan you have already been given. Second opinions on surgery advised elsewhere are routine. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.