ACL Reconstruction Surgery
at Aster MIMS Kannur
Your ACL is the primary stabiliser of the knee. When it tears, the knee buckles during pivoting, cutting, and deceleration. Arthroscopic ACL reconstruction rebuilds the ligament using your own tissue, restores stability, and protects the meniscus and cartilage from further damage. Dr. Vishnu uses anatomical tunnel placement and tailored graft selection to give you the best chance of returning to your sport.
What is the ACL and how does it tear?
The anterior cruciate ligament (ACL) is one of the four major ligaments inside the knee joint. It runs diagonally through the centre of the knee and prevents the shin bone from sliding forward relative to the thigh bone. More importantly, it controls the rotational stability of the knee during pivoting, cutting, and sudden deceleration. Without a functioning ACL, the knee buckles during these movements, making return to pivoting sports impossible and placing the meniscus at risk.
ACL tears most commonly occur during non-contact mechanisms: a sudden change of direction, an awkward landing from a jump, or a deceleration with the foot planted. You may hear or feel a popping sensation, followed by rapid swelling within the first few hours. The knee often feels unstable immediately, and weight-bearing becomes painful. An MRI confirms the diagnosis and reveals whether the meniscus or other structures have been damaged.
Reconstruction rather than direct repair is the standard of care because the torn ACL has a poor blood supply and does not heal reliably when sutured back together. Instead, a new ligament is built using a tendon graft harvested from your own body. The graft is positioned in the anatomical footprint of the original ACL and fixed securely inside bone tunnels, where it gradually incorporates and matures into a functioning ligament over 9 to 12 months.
Anatomical tunnel placement
Bone tunnels are drilled at the anatomical footprint of the original ACL, not in a generic position. Anatomical placement restores the natural rotational stability of the knee, which is critical for pivoting sports. This technique has been shown to produce superior functional outcomes compared to non-anatomical reconstruction.
Graft selection tailored to you
The choice of graft (hamstring, bone-patellar tendon-bone, or quadriceps tendon) depends on your sport, anatomy, activity demands, and personal preferences. Dr. Vishnu discusses the evidence behind each option so you can make an informed decision together.
Meniscus repair when possible
Meniscal tears found alongside ACL injuries are addressed during the same procedure. Whenever the tear pattern permits, the meniscus is repaired rather than removed. Preserving the meniscus protects the cartilage and significantly reduces the risk of early-onset arthritis.
Choosing the right graft
The graft is the tendon tissue used to build your new ACL. Each graft type has distinct advantages. The choice is a shared decision between surgeon and patient, based on your sport, anatomy, and recovery goals.
Hamstring
Lower harvest site pain
Smaller incision for graft harvest
Excellent for recreational athletes
Strong, multi-strand construct
Bone-Patellar Tendon-Bone
Bone-to-bone healing in tunnels
Gold standard for competitive athletes
Strongest published evidence base
Higher initial stiffness for early rehab
Quadriceps Tendon
Emerging preferred graft option
Lower anterior knee pain than BPTB
Strong, versatile graft for all sports
Ideal for revision ACL cases
Evidence note: Current evidence supports all three graft types for primary ACL reconstruction. The choice depends on patient-specific factors rather than graft superiority alone. Dr. Vishnu uses the graft that best matches your sport, anatomy, and rehabilitation capacity.
Who needs ACL reconstruction?
ACL reconstruction is recommended for patients with a confirmed ACL tear who have functional instability or wish to return to pivoting sports. The following scenarios are commonly treated at Aster MIMS Kannur.
Complete ACL Tear
Complete rupture confirmed on MRI in a patient with functional instability. The knee gives way during pivoting, cutting, or descending stairs, preventing return to normal activity.
ACL with Meniscus Damage
Combined ACL tear and meniscal injury. Reconstruction stabilises the knee and creates the conditions for meniscal repair to heal. Delay increases the risk of irreparable meniscal damage.
Recurrent Knee Instability
Repeated episodes of the knee giving way during daily activities or low-level sport, despite attempted physiotherapy and activity modification.
Competitive Athletes
Athletes in pivoting sports (football, kabaddi, badminton, basketball) who require a stable knee for cutting, jumping, and rapid direction changes. Reconstruction is the standard of care.
Young Active Patients
Patients with decades of activity ahead. Reconstruction protects the meniscus and cartilage from the cumulative damage caused by an unstable knee over many years.
Revision ACL
Failed previous ACL reconstruction with recurrent instability. Revision surgery addresses tunnel malposition, graft failure, or biological incorporation issues from the initial procedure.
From injury to return to sport
Assessment and planning
A thorough clinical examination of the knee, including Lachman test and pivot shift, confirms the diagnosis. MRI reveals the ACL tear and identifies any meniscal or cartilage damage. Dr. Vishnu discusses the graft options, expected timeline, and rehabilitation demands. Pre-operative physiotherapy may be recommended to optimise knee range of motion and quadriceps strength before surgery.
Arthroscopic surgery
Under spinal anaesthesia, the graft is harvested through a small incision and prepared on the back table. The knee is examined arthroscopically, the torn ACL remnant is debrided, and any meniscal tears are addressed. Bone tunnels are drilled at the anatomical ACL footprint on both the femur and tibia. The graft is passed through the tunnels and fixed securely. The procedure takes 60 to 90 minutes.
Early rehabilitation
A hinged knee brace is applied for 2 to 4 weeks. Weight-bearing with crutches begins on the day of surgery. Range of motion exercises start immediately. The focus in the first 6 weeks is protecting the graft, regaining full extension, and reactivating the quadriceps. Most patients are discharged within 24 to 48 hours. Structured physiotherapy begins within the first week.
Return to sport
Light jogging begins at 3 to 4 months. Sport-specific drills and agility training start at 6 months. Full competitive return is cleared at 9 to 12 months based on objective testing: quadriceps strength index, single-leg hop symmetry, and sport-specific functional assessment. Dr. Vishnu follows evidence-based return-to-sport criteria rather than arbitrary timelines.
Why Aster MIMS Kannur?
Aster MIMS Kannur is an NABH-accredited multispecialty hospital with a full arthroscopy suite, in-house MRI, and a dedicated physiotherapy department. The sports medicine programme combines surgical precision with structured rehabilitation protocols designed to return athletes to their sport safely.
Book at Aster MIMSNABH Accredited
National Accreditation Board for Hospitals certification, verifying adherence to patient safety and quality standards across every department.
Full HD Arthroscopy Suite
High-definition arthroscopy system with specialised instruments for ACL reconstruction, meniscal repair, and cartilage procedures. All sports injuries treated through keyhole techniques.
Structured Return-to-Sport Protocol
Evidence-based rehabilitation with objective milestones at each phase. Return to competitive sport is cleared by functional testing, not just calendar time.
Continuous Post-Operative Support
WhatsApp access to the surgical team throughout recovery. Video consultations for out-of-station patients. Rehabilitation guidance from surgery through return to sport.
ACL reconstruction FAQ
How do I know if my ACL is torn?
A torn ACL typically presents with a popping sound or sensation at the time of injury, rapid swelling within the first few hours, and a feeling of the knee giving way or being unstable during pivoting or direction changes. An MRI scan confirms the diagnosis and also shows whether the meniscus or other ligaments have been damaged. Clinical examination by an experienced surgeon can often diagnose the tear before the MRI.
Does a torn ACL always need surgery?
Not always. The decision depends on your activity demands, the degree of instability, whether the meniscus is damaged, and your age. Patients who participate in pivoting sports or who experience recurrent instability episodes are strong candidates for reconstruction. Patients with low activity demands and a stable knee may manage with physiotherapy and activity modification alone.
Which graft is best for ACL reconstruction?
There is no single best graft. Hamstring autograft offers lower harvest site pain and is excellent for recreational athletes. Bone-patellar tendon-bone provides bone-to-bone healing and is the gold standard for high-demand competitive athletes. Quadriceps tendon is an emerging preferred graft offering strength and versatility with lower anterior knee pain than BPTB. Dr. Vishnu discusses the options and recommends the graft best suited to your sport, anatomy, and goals.
How long is recovery after ACL surgery?
Recovery follows a structured timeline: brace and protected weight-bearing for 2 to 4 weeks, range of motion and strengthening exercises from Week 2, light jogging by 3 to 4 months, sport-specific training by 6 months, and full competitive return by 9 to 12 months. Dr. Vishnu clears patients for return to sport based on objective strength testing and functional assessment, not just time elapsed.
Can the meniscus be repaired during ACL surgery?
Yes, meniscal tears are commonly found alongside ACL injuries and are addressed during the same procedure. When the tear pattern permits, the meniscus is repaired rather than removed. Meniscal repair preserves the shock-absorbing function and protects the knee from developing arthritis in the long term. The decision to repair or partially remove is made during surgery based on the tear type and location.
Will I be able to play sports again?
Yes. Over 90% of patients return to sport after ACL reconstruction with structured rehabilitation. Return to competitive pivoting sports typically occurs at 9 to 12 months. Dr. Vishnu uses objective criteria including single-leg hop test, quadriceps strength index, and sport-specific functional tests to determine readiness. The goal is not just returning to sport, but returning safely with a low risk of re-injury.
What happens if I delay ACL surgery?
An ACL-deficient knee is unstable during pivoting and cutting movements. Each instability episode risks further damage to the meniscus and articular cartilage. Published studies show that delayed reconstruction is associated with higher rates of irreparable meniscal tears and cartilage damage. While surgery does not need to be performed immediately, unnecessary delay increases the risk of secondary damage to the joint.
Is ACL reconstruction done as keyhole surgery?
Yes, ACL reconstruction is performed entirely through arthroscopic (keyhole) techniques at Aster MIMS Kannur. The procedure uses 2 to 3 small incisions around the knee, each less than 1 cm. A high-definition camera inside the joint allows the surgeon to visualise the torn ligament, prepare the tunnels, and fix the graft under direct vision. The graft harvest requires a separate small incision over the donor tendon site.
ACL Recovery: Month-by-Month Guide
From protecting the graft in Month 1 through returning to competitive sport at 9 to 12 months. A real timeline from a PGI-trained surgeon.
Arthroscopic Knee Surgery at Aster MIMS
Meniscus repair, cartilage procedures, and diagnostic arthroscopy through minimally invasive keyhole techniques.