ACL { ANTERIOR CRUCIATE LIGAMENT } FREQUENTLY ASKED QUESTIONS

•                                                    ACL
•  { ANTERIOR CRUCIATE LIGAMENT } 
•   FREQUENTLY ASKED QUESTIONS 

DR MANU BORA, 

CONSULTANT ORTHOPAEDICS AND SPORTS MEDICINE, ARTEMIS HOSPITAL, GURGAON, DELHI NCR, INDIA.

An expert in arthrosporic surgeries of knee, shoulder, ankle and sports medicine, Dr Manu Bora is one of the few surgeons in Delhi NCR who practices All Inside ACL/PCL reconstruction with fibre Tape internal bracing. Dr Bora uses the most highly advanced and latest technology in ACL surgery that ensures instant recovery wherein the patient can walk pain-free without the support and bend the knee just a day after the surgery as opposed to the conventional technique that is painful and results in slow recovery. 
With countless successful surgeries to his credit, Dr Bora has mastered Total and Partial knee Replacement, Total Hip and shoulder Replacement and cartilage transplant. He also has commendable expertise in knee multiple ligaments and complex shoulder surgeries. Various awards and appreciation for excellence bestowed upon him stand proof of Dr Bora’s outstanding performance in orthopaedic and sports medicine. 
In the wake of serving the society selflessly, Dr Bora regularly engages into taking free sessions on injury prevention and increasing endurance in sports for athletes, CRPF, BSF and police and dedicates ample time at sports clubs and government sports authorities for the same. He also takes free office ergonomics sessions in various companies. 

Dr Manu Bora’s expertise and experience in orthopaedic and sports medicine are an  extension of his wide range of qualifications that include:

• MBBS – S.N Medical College, Jodhpur
• M.S (Orthopedics) – Grant Medical College, Mumbai
• Senior Residency – Sports Injury Center, Safdurjung Hospital, New Delhi
• Fellowship in Shoulder surgery from Istituto Clinico Humanitas, Milan, Italy
• Fellowship in Sports Medicine and Arthroplasty from Hospital Ambroise Pare, Paris
• Fellowship (Sports Medicine)- Hospital for Special Surgery, New York. Senior Residency from Sports Injury Centre, Safdurjung.

Consultation Places & Timings

1. Artemis Hospital, Gurgaon: 11 to 3 PM (Sundays Off)
2. Sofilux, 168 Eros City Square. Gurgaon: 5PM to 7PM (Monday Off)
3. Salubrity Clinics, A-2/37, Safdarjung Enclave, New Delhi: 4PM to 6PM (Tuesdays Only)
4. Umaid Heritage, Jodhpur, Rajasthan: On Appointment

CONTACT DETAILS AT THE END 

         can an anterior cruciate ligament tear Heal without surgery?

•  yes if the anterior cruciate ligament tear is grade 1 or there is a sprain in your ligament it can be very well healed with platelet-rich plasma injection therapy.

• how do you treat an anterior cruciate ligament injury?

• if you have anterior cruciate ligament sprain or grade 1 tear we can heal the injury by platelet-rich plasma injection. if your MRI shows that you have great 3 tears or completely torn anterior cruciate ligament injury then you will require arthroscopic surgery. you will achieve the fastest recovery with all inside ACL reconstruction with fibre tape internal brace. this is an arthroscopic surgery and after the surgery, the patient can walk a day after without any pain or support .he can bend his knees up to 90 degrees without any pain. the patient will resume jogging after one month of surgery and will resume running and sports after 3 months of surgery. if the Asian reconstruction is done by bio screws then it will take 6 to 7 months to resume sports and running. 

• can anterior cruciate ligament injury Heal itself?

•  if there is a Grade One tear it can Heal itself sometimes with good physical therapy and exercises.

•  can you walk with a torn anterior cruciate ligament? 

• after the anterior cruciate ligament tear, you might experience pain and swelling for a couple of days after that the pain and swelling will subsidize and you can be able to walk with an anterior cruciate ligament tear. 

• how serious is torn anterior cruciate ligament?

•  generally, people can do their normal activities including walking with a year however if they don't go for treatment then their knee will get degeneration in 10 to 15 years after the tear. and it is difficult for them to do running and playing sports because of the instability of the knee. 

• how painful is the anterior cruciate ligament surgery?

•  if the surgery is done by the screw then you might feel pain for a week or two bending the knee is also quite painful. if the surgery is done by all inside a cell reconstruction with fibre tape internal brace the postoperative pain is very less you can bend your knees up to 90 degrees from the next day of surgery and you can easily walk without any support and without any pain. 

• what is the fastest way to recover from anterior cruciate ligament surgery? 

• all inside a c l reconstruction with fibre tape internet brace surgery has the fastest recovery. after the surgery, the patient can resume jogging within one month and can resume running and sports within 3 months of the surgery.

•  is anterior cruciate ligament surgery a major surgery? 

• anterior cruciate ligament surgery is done by arthroscopy it is a pinhole surgery. it has a very fast recovery with minimal pain and minimal blood loss. 

• do they use screw in the anterior cruciate ligament surgery?

•  yes, most of the surgeon uses bio screw or titanium screw in this surgery. but if an athlete wants a very fast recovery then he should go for all-inside ACL reconstruction with fibre TAPE INTERNAL brace . in this surgery very small flexible button loops are used for the ligament fixation. Dr Manu Bora uses tight rope by Arthrex in this surgery. after the operation, the patient can resume running and sports within 3 months. 

• can I Climb stairs after the anterior cruciate ligament surgery? 

• yes, when we do the surgery biol inside ACL reconstruction with fibre tape internal brace the patient can climb stairs after one day of surgery. 

• how soon can you walk after anterior cruciate ligament surgery? 

• if the surgery is done by all-inside anterior cruciate ligament reconstruction with fibre tape internal brace you can resume walking without any support and without pain in just one day after surgery. 

• how do you poop after anterior cruciate ligament surgery? 

• the patient will have to wear a knee extension brace for 3 weeks after the surgery so he can use a western-style commode. 

• do and don'ts after a c l reconstruction surgery?

•  if the surgery is done by all-inside anterior cruciate ligament reconstruction with fibre tape internet brace the patient can walk a day after surgery he can bend his knees up to 90 degrees after one day of the surgery, he will be doing lunges and squats within 2 weeks after surgery. he should be wearing a knee extension brace for 3 weeks after the surgery the brace can be removed while doing the exercises.

•  how long I will be on crutches after anterior cruciate ligament surgery? 

• if your surgery is done by all-inside anterior cruciate ligament reconstruction with fibre tape internal brace you will not require catches for walking. the patient can walk without pain and without crutches after one day of surgery. ACL reconstruction is done by bio screw or another kind of screws then he might require creatures for walking depending upon how much pain is experiencing. generally, the patient use sketches for two to three weeks after the bio screw surgery. 

• is walking is good for anterior cruciate ligament surgery recovery?

•  yes, the patient is encouraged to do his all daily routine and to walk after the surgery. walking is important for quick recovery after the ACL reconstruction surgery. with all inside a c l reconstruction with fibre tape internal brace the patient can resume walk without pain and without support just after one day of surgery. 

• how long do you wear a brace after anterior cruciate ligament surgery? 

• knee extension brace is given for 3 weeks after the surgery and the patient has to remove the brace while doing exercises.

•  how long will I be off work after anterior cruciate ligament surgery? 

• if the surgery is done by all-inside anterior cruciate ligament reconstruction with fibre tape internal brace generally you have to be at home for 7 to 10 days. if the surgery is done by other methods like using bio screws or Titanium screws without internal brace then the patient will require much longer duration at home before joining the work.

•  how long does anterior cruciate ligament surgery take? 

• generally, it takes 30 to 45 minutes.

•  why is ACL surgery recovery so long?

•  because ACL reconstruction is done by patients own hamstring tendon and this Tandon is fixed to the bone by bio screw or adjustable loop button. recovery is dependent upon what kind of fixation device is used. with bio screw fixation recovery generally takes 6 to 7 months and the patient can resume running and sports after 6 to 7 months of surgery. surgery done by all inside and cruciate ligament reconstruction with fibre tape internal brace recovery is much faster the patient can resume running and sports within 3 months of the surgery. when a surgeon puts hamstring tendon in the knee as ACL the tendon takes around 6 months to revascularized and get the strength. only after that, the patient can resume running and sports. when the surgery is done by all-inside ACL reconstruction with fibre tape internal bracing the fibre tape internal brace takes away the stress from the healing tissue and patient can resume running and sports after 3 months of surgery and chances of graft lengthening and re-tear is reduced significantly. 

• Is ACL surgery worth?

• The anterior cruciate ligament is the main knee stabilizer, and it provides stability to the knee when your anterior cruciate ligament is torn then your knee will become unstable and you will feel instability,  it will be difficult for you to do sports and running.  with the torn anterior cruciate ligament the can undergo Rapid degeneration and leads to secondary osteoarthritis very early. to prevent the osteoarthritis and maintain the active life is treatment is very important. after all-inside anterior cruciate ligament reconstruction with fibre tape internal brace, the patient can resume running and sports within 3 months of surgery. 

• Is it bad to wait for ACL surgery?

• most of the patient comes for the surgery within one or two months of the injury. waiting off more months can lead to muscle degeneration in the leg and can lead to the knee cartilage degeneration also. Ideally, the patient should wait for 2 to 3 weeks so that the inflammation and swelling subsidize and then he can undergo surgery.

• Can ACL grow back?

•  the torn anterior cruciate ligament doesn't grow back . if the anterior cruciate ligament is completely torn Anterior cruciate ligament reconstruction is required.

• What happens if ACL injury is not treated?

• If a patient doesn't take any treatment for his torn anterior cruciate ligament then he will not be able to pursue his daily active life like running, dancing, playing Sports. the thigh muscles will get degeneration.  Due to constant instability of the knee, the cartilage and other structures in the knee can also degenerate rapidly.  secondary osteoarthritis of the knee will develop in a few years. 

•  How do you tell if ACL is torn or sprained?

•  if the anterior cruciate ligament is completely torn then the patient will feel instability in the knee, it will be difficult for the patient to do active sports and running and he will experience regular twisting of the knee.

• What is worse ACL or MCL tear?

•  both anterior cruciate ligament and the Medial Collateral ligament is very important for the stability of the knee.  if any one of them is completely torn then it has to be reconstructed surgically

• Can you walk with a partially torn ACL?

• the patient can walk after a partially torn ACL. 

•  Can walking on a torn ACL make it worse?

• Walking with torn anterior cruciate ligament will not make it worse.

• Where is ACL pain felt?

•  after the anterior cruciate ligament injury, the patient will experience pain and swelling in the knee for a couple of days.

• Can you feel a torn ACL?

•  if your anterior cruciate ligament is torn you will feel instability in the knee and you will not feel confident in running and playing sports,  you will feel frequent twisting of the knee.

•  How do you tell if you Retore your ACL?

•  you will feel the same symptoms of knee instability and loss of confidence if your anterior cruciate ligament is torn again.

•  What does a torn ACL feel like after a week?

•  after a week of injury, the pain and swelling in the knee subsidize.  the anterior cruciate ligament is completely torn then you will feel instability in your knee and you will lose confidence in running and playing Sports.

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• Does ACL tear hurt all time?

•  after anterior cruciate ligament tear, you will feel pain and swelling in the need for 4 to 5 days. after this, the pain and swelling in the knee will subsidize.  if you are feeling a constant pain in the knee then there might be a cartilage injury or a meniscus injury

•  Why is an ACL injury so bad?

•  if anterior cruciate ligament tear is left untreated then the knee cartilage will degenerate at a very Rapid rate and secondary osteoarthritis of the knee will develop in a few years

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• Can you put weight on a torn ACL?

•  a patient can put full weight on a torn anterior cruciate ligament

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• Can I live without ACL?

• living without anterior cruciate ligament is like living without running, dancing and sports.

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• How do you strengthen your ACL?

• By doing anterior cruciate ligament injury preventing exercises an athlete can prevent his anterior cruciate ligament from getting injured.

• What is the best exercise for a torn ACL?

• thigh muscle strengthening and balance training exercises.

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• Can ACL heal naturally?

•  a complete tear of the anterior cruciate ligament will not Heal by itself

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• How can I strengthen my ACL without surgery?

•  strength training including eccentric exercises, balance training and proprioception exercises can prevent the anterior cruciate ligament from getting injured.

• What should I avoid with a torn ACL?

• A patient with torn anterior cruciate ligament should avoid fast running and active Sports.  after the arthroscopic all-inside anterior cruciate ligament reconstruction with fibre tape internal brace a patient can resume running and sports after 3 months of the surgery.
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• What helps ligaments heal faster?

•  regular physical therapy under the guidance of a trained physiotherapist or a sports medicine specialist will help your ligament to heal faster

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• How can I check my ACL at home?
•  a patient with torn anterior cruciate ligament will feel instability in the knee.

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• What does a partially torn ACL feel like?

•  patients with Partially or completely found anterior cruciate ligament can feel pain and swelling in the knee, They might feel that the knee is unstable and they will experience giving out feeling in the knee.

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• Does a Grade 1 ACL tear need surgery?

•  grade 1 anterior cruciate ligament tear can be healed completely with platelet-rich plasma treatment it really needs surgery.
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• How much does ACL surgery cost?

•  arthroscopic all-inside anterior cruciate reconstruction with fibre tape internal brace cost from 1 lakh to 2.5 lakh rupees depending upon which implant and what room category you choose in the hospital.

• Can you walk with a Grade 3 ACL tear?

•  a patient can walk with grade 3 anterior cruciate ligament tear but he will feel that the knee is unstable and  he will experience “give out” feeling in the knee

• What are the long term effects of a torn ACL?

•  long term effect of an anterior cruciate ligament tear is  Rapid development of secondary osteoarthritis of the knee.

• How successful is ACL surgery?

•  arthroscopic anterior cruciate ligament reconstruction has a 99.9% success rate.  after all-inside anterior cruciate ligament reconstruction with fibre tape internal brace then the patient can resume running and sports within 3 months of the surgery 

• How long does a Grade 3 ACL tear take to heal?

• grade 3 anterior cruciate ligament don't Heal naturally.  patient with a grade 3 ACL tear needs arthroscopic all-inside ACL reconstruction with fibre tape internal brace,  after the surgery he can resume running and sports within 3 months

• Is surgery always needed for a torn ACL?

•  if an anterior cruciate ligament tear patient is young and does not have any symptoms of high-grade osteoarthritis,  it is advisable to go for the surgical treatment to prevent the Rapid development of knee secondary osteoarthritis.

• Why do ACL reconstructions fail?

•  anterior cruciate ligament reconstruction surgery fails if the surgery is not done accurately or if some complications like infection develop in the post-operative period

•  What can go wrong with ACL surgery?

• Accurate placement of femoral and tibial Tunnel is very important in the success of anterior cruciate ligament surgery if during the surgery tunnel placement is not accurate than the anterior cruciate ligament surgery might fail in the future.

• Is second ACL surgery easier?

•  second anterior cruciate ligament surgery is challenging as there is an implant present in the Tibia and femur,  this implant might be a screw or an adjustable loop button.  second time or revision anterior cruciate ligament surgery is done with screw fixation has a higher chance of failure because of the widening of the tunnel and a loose graft.  all-inside anterior cruciate ligament reconstruction with fibre tape internal brace is better for a revision anterior cruciate ligament surgery as the fixation is not dependent on the intramedullary bone and tunnel condition,  in this the fixation is on the cortex.

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