ACL Surgery Cost in India

Last Modified: July 17, 2020  |   Created on: May 5, 2020
Orthopedics

“The cost of ACL Reconstruction surgery in India starts from $2500. The orthopedic hospitals in India promise unparalleled health treatments at low-cost packages.

The cost of ACL reconstruction surgery in India ranges from USD 3000 to USD 5000. Indian hospitals offer affordable health packages inclusive of the evaluation and surgery cost. You can expect an economical and reliable treatment at the top hospitals in India.

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What are the factors that affect the cost of ACL surgery in India?

This ACL surgery price may vary depending on factors such as:

  • Type of graft used
  • Extent of injury
  • Whether addition surgery is required
  • Choice of hospital: location and accreditations
  • Surgeon’s experience 
  • Room category

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What is an ACL reconstruction surgery?

ACL reconstruction is a surgical procedure to rebuild or replace the damaged anterior cruciate ligament (ACL) in the knee. This reconstructive surgery aims to restore the stability of the ligament and maintain full range of motion. Although, a common procedure, ACL reconstruction is a major surgery with certain risks and potential complications. A patient is initially treated with some non-invasive options and when they fail to improve the condition, a surgery is suggested. 

ACL reconstruction in India

India ranks amongst the top medical travel destinations of the world. Every year, thousands of people from different countries get high-quality treatment at the best hospitals in New Delhi, Mumbai, Chennai, Hyderabad and other cities. ACL reconstruction is a complex surgical procedure that should be performed by an experienced and skilled surgeon at an excellent medical facility. 

The best ACL reconstruction surgery hospitals in India are first-rated medical centres that cater to a large volume of domestic as well as international patients on a regular basis. These hospitals have advanced surgical instruments and most updated operation theatres which minimizes the risk of infection and other complications during the surgery. They are certified by the national and international accreditation organizations for their standard of patient care services. 

The orthopaedic doctors in India are world-renowned for their knowledge and expertise in the field of surgery. They have completed their training the advanced techniques from the top medical institutions of the world. The best ACL surgeons in India have decades of experience in performing various kinds of surgeries with successful outcomes. 

Another important reason behind India’s popularity is the low cost of ACL reconstruction in India compared to other countries, especially those in Europe. A patient from abroad may save a significant amount of money if they choose to travel to India for their procedure. The overall ACL surgery cost in India is highly affordable for international patients, even after including the expense for travel, accommodation and post-surgery rehabilitation.

What is ACL?

The bone structure of a knee joint comprises the femur, tibia, and patella. It is supported by four types of main ligaments which connect these to each other. The Anterior Cruciate Ligament ACL is one of these ligaments that connect femur bone to tibia within the knee. It is one of the most commonly injured ligaments, especially in the athletes. The ACL is responsible for preventing the tibia from sliding out in front of the femur. This provides the knee rotational stability and flexibility of movement.

Who is a suitable candidate for knee ligament surgery?

The anterior cruciate ligament (ACL) is a common knee injury that affects the ligaments. People who take part in high-risk sports, such as basketball, football, skiing, and soccer are generally considered to be more prone to this injury.

Most of the ACL injuries occur in combination with tear or damage to other knee parts such as the meniscus, articular cartilage, or other ligaments. The articular cartilage is the layer that covers the weight-bearing surface of the knee, while the meniscus are the layer present on either side of the knee, between the cartilage surfaces of the bones femur and tibia. The meniscus is the shock absorber for the knee that reduce the stress between the tibia and the femur.

The symptoms of functional instability of the knee includes pain or inability to perform the daily activities. This increases the chances of further knee damage.

Some patients may also have bruises due the bones beneath the cartilage surface. A magnetic resonance imaging (MRI) scan can usually be used to detect such injuries to the overlying articular cartilage. If the non-invasive treatment options are unable to provide relief from the condition, the doctor may recommend surgery to treat complete ACL damage. Patients who are suitable for a reconstruction surgery are: 

  • Adults who are physically active and wish to return to contact sports or strenuous activities, especially when these activities may require pivoting, twisting, turning, or strong sideways movements of the knee. 
  • People who have combined injuries – other knee injuries along with an ACL tear
  • Teenagers or older children having closed growth plates. 

In younger children, there is a risk of damage to the growth plate due to an ACL surgery. It can result in problems related to the child’s growth. The surgeon may suggest delaying or modifying the ACL reconstruction surgery to reduce the risk of damage to the growth plate.

In general, the operation is a preferred option for the patients who 

  • Are younger than 25 years
  • Have a significant anterior tibial subluxation
  • Have additional intra-articular damage

However, non-surgical method of treatment is considered to a reasonable option when the above mentioned conditions are not met. A non-invasive treatment is a good option for elderly people who have a low activity level. Also, it is preferred when the patient has minimal or no anterior tibial subluxation, no additional intra-articular injury.

Types of ACL surgery

An injured or torn ACL is treated by sewing the ligament back together, rather a reconstruction surgery using a connective tissue graft is required for a complete healing. A graft can be taken from both types of connective tissues – ligaments and tendons. These tissue grafts help rebuild or replace the injured ACL. The injured ligament heals around the graft over a period of time, usually several months. 

There are different types grafts and ACL surgery procedures that can be used to treat the ACL injury. The selection of a suitable graft type is personalized for each patient. The doctor will recommend the graft on basis of various factors including

  • Pros and cons of each graft type
  • Patient’s age
  • Lifestyle and activity level of the patient
  • Whether any other associated injuries also needs to be treated

ACL reconstruction with Autograft: 

An autograft is a piece of connective tissue obtained from the patient’s own body. For an autograft, a piece of connective tissue can be taken from the patellar (kneecap) tendon, hamstring or a quadriceps tendon. Patellar tendon is considered to be the gold standard for ACL autograft reconstruction. The tendon from patellar site heal itself and the missing portion re-grows over time. An ACL reconstruction with an autograft requires a large incision, longer surgery time, and results in more post-operative pain than an allograft reconstruction.

Patellar Tendon Autograft: 

The bone-patellar tendon autograft is a widely used standard ACL reconstruction graft. It is taken from the middle third of the patellar tendon along with the bone from the surface of the kneecap (patella) and bone from the shin-bone (tibia). This autograft has many advantages including the ability to properly restore stability of the knee, quick incorporation and low rate of re-tearing. Some disadvantages of patellar autograft are temporary or long-term pain in the front part of the knee, require a larger incision, a slight loss of movement, and pain immediately after the reconstruction surgery. This autograft is typically recommended for patients who are high-level or elite athletes, or those who had failed prior ACL reconstructions. It might not be a suitable option for patients who have conditions such as patellar tendonitis and patellofemoral syndrome. Also, people who have jobs that require frequent kneeling, such as gardeners, floor installers and plumbers, or those who are involves in long-distance or repetitive running (marathon runners) also do not preferred this graft.

Hamstring Tendon Autograft

For an ACL surgery, the surgeon might use two of the five hamstring tendons to reconstruct the ACL. With this type of autograft, there is no need to harvest the bone with the hamstring tendons. The post-surgery pain immediately after the operation is comparatively less than pain with patellar autografts. Other advantages of hamstring autografts are restoration of knee stability, use of a smaller incision and reduced chances of long-term knee pain. The disadvantages of using this graft is that the reconstructed ligament might not be as strong as the patellar graft, it has a slower process of graft incorporation and healing and there can be a slight loss in tendon strength when the knee is bending (end flexion range). This autograft is often used in younger patient who have an active lifestyle and those who often kneel. Patients who are not recommended this graft have very flexible joints in their body or have a history of MCL sprain.

Quadriceps Tendon Autograft

This graft comes from thigh (quadriceps) tendon along with bone from the kneecap, with a bone on one end and soft tissue on the other. It is not as commonly used as the other autografts but it is considered to be reliable. The advantages of a quadriceps graft is that results in less long-term knee pain in comparison to patellar graft, have reliable strength and healing bone at one end. Patient might experience more initial pain with this graft than a hamstring autograft, but less than the patellar graft.

ACL reconstruction with Allograft:

An allograft is a piece of connective tissue obtained from a cadaver donor. These grafts are sourced from a tissue bank. The benefit of using this type of graft for reconstruction is that it requires only one incision, a shorter surgical time, cause less pain, less donor site surgical pain, and faster patient recovery. As the surgical morbidity associated with allograft is very limited, it provides aesthetic benefits for the patient.

The disadvantages of using this graft is that it carries the risk of transmission of infectious diseases such as HIV and Hepatitis C viral infections, chances of rejection by immune system, slow remodelling and integration processes as it requires a sterilization methods (gamma rays). The sterilization process is important to reduce the risk of transmission of infection from the donor tissue.

ACL reconstruction with Xenograft or synthetic/artificial grafts:

A xenograft is obtained from the connective tissue of non-human or animal source. The artificial ligament graft are made from synthetic materials and have been under trials to check their performance. The xenografts and synthetic grafts are expected to show excellent potential for use in the future.

There are two different techniques which can be used for ACL reconstruction: Extra-articular and Intra-articular. 

What can I do before the surgery?

Before a surgical treatment such as ACL reconstruction, the patient is normally recommended to physical therapy sessions. This is important as patients might have a stiff, swollen knee joint that has restricted range of motion when ACL surgery is suggested. It may cause significant concern while regaining motion post surgery. Usually, it takes around three or more weeks from the time of injury to restore a full range of motion. 

The patient may also be recommended to wear brace in the case of certain ligament injuries  to allow some healing prior to ACL reconstruction.

What happens during the ACL reconstruction surgery?

ACL reconstruction is performed as an outpatient procedure, which means the patient will not have to be hospitalized after the surgery. The operation generally lasts for 2 or more hours. 

The surgery might be performed with either a general or regional anesthesia. The operating surgeon and anaesthesiologist will help you with the choice of anaesthesia depending on the procedure and extent of injury. A general anaesthesia is often used as it puts the patient to sleep during the operating.

The two types of anaesthesia that can be used- 

General anaesthesia involves a combination of medications and gases administered through an IV that makes the patient unconscious. They will not feel any pain during the surgery. Some patients might receive a peripheral nerve block infusion in addition to general anesthesia to control pain during and after surgery.

Regional anesthesia or a nerve block is given as an injection around the certain nerves to numb a large area of the body. Patients also receive sedation along with regional anesthesia to help them remain relaxed and comfortable during the operation.

  • During the surgery, the surgeon removes the torn or damages ACL and replace it with an auto or allo- graft. This is usually done with an arthroscopic technique. 
  • The surgeon makes a small incision to remove a tendon in case of an autograft, depending on the type of autograft is used. 
  • Using a thin, flexible instrument called arthroscope, the surgeon makes several small punctures to see the insides of the knee joint and insert surgical instruments. 
  • In case of an allograft, the tendons are obtained from a cadaver and the surgery is shorter as it doesn’t require the removal of tendon from the patient.
  • Then the graft is placed through the bone structures and fixed to the femur (thigh-bone), and tibia (shin-bone) using screws and stitches. 
  • Once the incisions is closed with stitches, a sterile dressing is placed over the surgical wound. 

The arthroscope enables the surgeon to view the joint and ligaments, and perform the surgery using special surgical tools around the structures, instead of cutting through them as in case of an open surgery. This is a minimally invasive surgery approach which generally involves a quicker recovery and less post-operative pain compared to an open surgery. It involves the use of smaller incisions which causes less trauma and damage to tissues involved in the procedure. 

The surgeon may recommend other procedures that can be performed in addition to ACL surgery for a holistic treatment approach:

Meniscus repair: It is the surgical procedure to repair or trim a torn meniscus. There are two menisci in the knee that are made of cartilage. Their role is to act like a shock absorber for the knee joint.

Patellar realignment: It is the surgical procedure to reposition the patella (kneecap).

Other ligament reconstructions: There are four ligaments in the knee, including ACL. The surgery can be performed to treat the injury to other knee ligaments with reconstruction, depending on the extent of damage.

Synovectomy: In this surgery, a part of an inflamed synovial membrane, tissues that line joints such as knee, are removed to improve the condition.

How is recovery after ACL reconstruction surgery?

After the surgery, the patient is shifted to a recovery room and the operated leg is placed in a hinged brace. The braces will allow the patient to bend as well as straighten the knee. Most patients wear this brace for five to six weeks post surgery. The patient may put some weight on the operated leg while using crutches, but this depends on the surgeon’s preference and whether other procedures are performed.

During the first 2 weeks after surgery, it is advisable to keep the wound clean and dry. The doctor also suggest an early emphasis on regaining the ability to fully straighten or bend the knee (flexion) as well as restore the quadriceps control. The patient is also recommended icing the knee regularly to reduce swelling and pain. 

The doctor will provide the necessary instructions at the time of discharge from the hospital. Most patients are able to return to sports when pain and swelling subsides, full range of motion of the knee is regained, and muscle strength as well as functional use of the leg is restored. The sense of balance and control of the leg is restored with special exercises designed to improve neuromuscular control. It typically takes 4 to 6 months. Although, a functional brace is not needed when the patient returns to sports activities after a successful ACL reconstruction, some patients feel more secure while wearing the brace.

Rehabilitation is a very important part of recovery after an ACL reconstruction surgery. The physical therapy begins with some light exercises immediately after the surgery. This is crucial for a successful ACL reconstructive surgery and the patient should strictly follow the physical therapy regime. The rehabilitation of ACL reconstruction aims to reduce swelling on the knee, help restore mobility of the kneecap to prevent problems such as anterior knee pain, regain a full range of motion, and strengthen the quadriceps as well as hamstring muscles. With the use of new surgical techniques and more reliable graft fixations, now-a-days physical therapy involves an accelerated rehabilitation course.

What are the risks and potential complications of anterior cruciate ligament (ACL) surgery?

ACL surgery, similar to all the other surgeries, involve certain risks and potential complications. Some complications can be serious and even become life threatening in certain cases. They may occur during surgery or recovery. 

Potential complications involved in an ACL surgery include: 

  • The graft fails to heal
  • Growth plate injury, especially in young children
  • Risk of viral infection HIV or hepatitis with an allograft reconstruction
  • Instability and stiffness of the knee
  • Pain in the kneecap, especially in the case of patellar tendon autografts
  • Damage to the nerves, muscles, or blood vessels in the operated region
  • Weakness and rupture of the patellar tendon while harvesting for an autograft
  • Loss of range of motion
  • Weakness or numbness in the leg 

Some general risks of a surgery also include: 

  • Reaction to anaesthesia, including an allergic reaction or breathing problems 
  • Excessive bleeding that may lead to a shock
  • Blood clot such as a deep vein thrombosis (DVT). This may block the blood flow in one of the legs or travel to the lungs, causing a pulmonary embolism.
  • Infection 

Frequently asked Questions (FAQs) about ACL Surgery in India

Q. Are Indian hospitals well-equipped for procedure such as ACL reconstruction?

The best orthopaedic hospitals in India are internationally accredited hospitals with top-notch infrastructure. The hospitals have centre of excellences for bone and musculoskeletal conditions and offer a variety of treatments for different conditions. Numerous patients from all over the world travel to India on a medical visa for good quality orthopaedic care, including joint replacement surgery, ACL reconstruction, arthroplasty procedures, meniscus surgery and many more. The top ACL reconstruction hospitals in Delhi have highly sophisticated and advanced technology, including computer navigation, image-guided systems and robotic surgery. These techniques offer improved success rate and better recovery for patients.

Q. How long does the ACL surgery take?

Normally, an ACL reconstruction takes about 60 to 90 minutes. After operation, patient will be in the recovery room for 1 – 2 hours.

Q. Is surgery the only treatment for an injured ACL?

Surgery is not the only option in every case of injured ACL. There are some non-invasive treatment methods that might be recommended, including weeks of bracing, applying ice, and elevation, and prescribed anti-inflammatory medications. The goal with these treatments is to reduce the pain and restore the range of motion as well as strength of the knee. However, for patient who are actively involved in sports or have work that includes physical activities, such as pivoting movements, surgical reconstruction of the ACL may be the best treatment option.

Q. How long will I have to use crutches?

Most patients have to use crutches for about a week, and then they can switch to a cane or other assistive equipment for next two weeks. However, this may vary depending on the extent of the ACL injury and the recovery timeline.

Q. What are restrictions after ACL surgery?

The doctor will discuss all the post-operative guidelines and restrictions in detail before the discharge. Patients are asked to avoid any strenuous activity, other than physical therapy for approximately 12 weeks. This involves no mowing lawns, snow blowing or shoveling and sports activities such as skiing, football, soccer, basketball, hiking, and any contact sport. It usually takes about six months to return to strenuous physical activity and high-impact sport after following the physical therapy protocol. During rehabilitation, initially swimming and exercise biking are two activities that are allowed, followed by the StairMaster and treadmill later on.  It is important to avoid strenuous physical activity as ACL graft placed in the knee during the surgery takes six months to heal, re-vascularize and gain strength. The graft becomes weaker for some time after it is implanted.

Q. When can I return to work post ACL surgery?

This depends on the nature of job and healing. Most patient after ACL surgery are able to return to a desk-type job in about one to two weeks. For people involved in moderately physical work, it may take up to three months to resume work and up to six months for strenuous physical work.

Q. When will I be able to drive after ACL reconstruction surgery?

Generally, the doctor will allow driving when the pain medication can be discontinued, there is no need for crutches and knee immobilizer, and you have regained enough control and strength of the knee after reconstruction. Most patient can start driving in about two weeks, but patients who had surgery for the left knee may be able to drive an automatic car sooner.

Vanshika Rawat

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is very knowledgeable in the field of science and healthcare and has worked under brilliant scientists during her higher education. Vanshika obtained her degrees in Masters in Science and Bachelors in Science (Microbiology with Hons.) from renowned institutions - Panjab University and University of Delhi.
Dr. Suneet Singh

Verified By Dr. Suneet Singh

Dr. Suneet is a doctor-turned-Hospital Administrator with a rich 12 years plus multi-faceted experience in the field of operations management, Corporate and Public Health Administration. Formerly a practicing doctor, Dr. Suneet holds a post-graduate degree in Hospital and Healthcare management from one of the country's esteemed Tata Institute of Social Sciences (TISS)

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