ACL Treatment Options

Non-surgical Treatment

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In people over the age of 55 with a sedentary life style may not need a surgery, but proper rehabilitation to optimise the muscle condition to minimise the risk of further deterioration and wear and tear of the knee joint. 

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PRP Injection

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Partial tears of the ACL can be mended by Platelet Rich Plasma injections. Patient may typically need 1 to 3 injections at the intervals of 1 month each. 4 to 6 weeks post injection you will get examined clinically to reassess the effectiveness of the injection. 

 

Internal Bracing Technique

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Internal Bracing works well for patients with thin tendon grafts to augment the graft. Although Internal bracing alone has been heavily advertised, the long term outcomes of the internal bracing alone is not established. The tendon graft harvested from oneself will get incorporated into the body as the bone inter-digitations grow into tendon graft. With internal bracing long term wear and tear is expected to make it weak and non-functional. 

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ACL Reconstruction Hamstring Grafts

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ACL Surgery using hamstring grafts is the commonest technique used worldwide as it gives reliable outcomes and the graft donor site problems are rare.  The incision size is small and the hamstring strength returns to normal within 3 months. 

 

ACL Reconstruction BTB Graft

 

ACL surgery using BTB (Bone-Tendon-Bone) graft from the front of the knee is another very useful technique for reconstruction.  The advantage is that the bone to bone healing takes place more quickly and in an organised fashion. However the donor site pain, tenderness, longer incision makes it less popular option, however, in some this option is preferred on an individual basis. 

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ACL Reconstruction Quads tendon Graft

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ACL surgery can be performed using the quads tendon above the patella (knee cap).The thick graft size makes it an attractive option, however the donor site pain and weakness remains for a longer duration in these patients. 

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ACL Reconstruction Peroneal tendon Graft

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Peroneal tendon is an attractive option for the ACL surgery, however, the evidence for the long term efficacy of this tendon as a graft is still being evaluated. 

 

ACL Reconstruction Single Bundle 

 

The single bundle technique has been in use in most premier centres across the world. If is effective and technically sound to reproduce with proper training. 

 

ACL Reconstruction Double Bundle

 

ACL reconstruction with two bundles does replicate the anatomy well, however the techniue is difficult to replicate and the outcomes reported have not been uniform across the fraternity. And with 2 tunnels, revisionsurgery if needed becomes more complicated. 

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ACL Reconstruction - All-inside technique

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This technique is best used when the graft size is thin and getting longer graft is not possible. In this technique titanium buttons are used on both sides. The fixation with this provides secure support and avoids the problems due to liquification of the bio-composite screw.

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ACL Reconstruction - Tight Rope & BioComposite Screw Fixation

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This is the commonest way of fixing the graft in ACL reconstruction where a titanium button is used on the femoral (thigh bone) side and bio-composite screw on the tibial (leg bone) side. It provides secure fixation and good outcomes. 

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ACL Reconstruction - Anatomical 

 

The femoral tunnel in the place where the ACL fibers are attached and in the same angle of pull is better as it provides better rotational stability. 

 

ACL Reconstruction - Non-Anatomical

 

Some surgeons follow the trans-tibial tunnel technique to drill the femoral tunnel as well. However, this leads to poor rotational stability. 

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