Most people who tear their anterior cruciate ligament remember the exact moment. A twist while turning, a pop that is sometimes audible, and a knee that swells within a couple of hours. Then, often, a few weeks later the swelling settles and the knee feels almost normal again — which is precisely why so many ACL tears go undiagnosed.

The problem shows itself later: the knee gives way when you change direction, and every episode of giving way damages the meniscus and cartilage a little more.

Dr. Sunil Choudhary, FRCS (Trauma & Orthopaedics), a UK-trained knee surgeon practising in Faridabad, Haryana. This page covers ACL treatment in Faridabad honestly — including the fact that not everyone with a torn ACL needs an operation.

How you know you have torn your ACL

  • A twisting or pivoting injury, often non-contact — landing, turning, or decelerating suddenly
  • A pop felt or heard at the time
  • Swelling within two to six hours — blood in the joint — as opposed to swelling appearing the next day
  • Inability to continue playing
  • Later: the knee giving way on turning, on stairs, or on uneven ground
  • A persistent sense that the knee cannot be trusted

Why the ACL does not heal on its own

The ACL sits inside the joint, bathed in synovial fluid, with a limited blood supply. When it ruptures completely, the torn ends retract, and the fluid environment prevents the healing process that works for ligaments outside the joint such as the MCL. A complete tear therefore does not reliably reattach itself — which is why ACL reconstruction rebuilds the ligament with a graft rather than stitching the old one together. Partial tears are different, and some do stabilise with rehabilitation alone.

Do you actually need surgery?

Not everyone does. The decision depends far more on what you need your knee to do than on what the MRI says.

Reconstruction is usually recommended if

  • You play or want to return to pivoting sports — football, cricket, badminton, kabaddi, basketball
  • Your knee gives way during ordinary daily activities
  • There is an associated repairable meniscus tear — repairing a meniscus in an unstable knee usually fails
  • You have a physically demanding occupation requiring stability on uneven ground
  • You are young, with many years of loading ahead of the knee

Rehabilitation alone may be appropriate if

  • You are older and lead a less pivot-intensive life
  • The knee is stable in daily activity, with no giving way
  • You are willing to modify activity and commit to serious quadriceps and hamstring strengthening
  • The tear is partial with a stable examination

Repeated giving-way episodes progressively damage the meniscus and articular cartilage and accelerate arthritis. That consequence, rather than the tear itself, is the strongest argument for reconstruction in an active person.

How we confirm the diagnosis

Clinical examination comes first. The Lachman test is the most sensitive, with the pivot shift test confirming rotational instability. I examine both knees and compare, and I specifically check the collateral ligaments, the PCL and the menisci, because combined injuries are common and change the plan. MRI then confirms the tear, grades it, and — more importantly — identifies the associated injuries.

Graft choice — hamstring, quadriceps, BPTB or peroneus longus

The new ligament is built from your own tissue in most cases. Each option has genuine trade-offs, and as your best ACL specialist in Faridabad my job is to discuss which suits you rather than use the same graft for everyone.

  • Hamstring tendon — the most commonly used worldwide. Reliable, small incision, minimal anterior knee pain. Some temporary hamstring weakness
  • Quadriceps tendon — a strong graft with a large cross-section, increasingly popular, with less kneeling pain than BPTB
  • Bone-patellar tendon-bone (BPTB) — excellent bone-to-bone healing, historically favoured for high-demand athletes. Can cause anterior knee pain and difficulty kneeling
  • Peroneus longus — used in some Indian practice, preserving the knee flexors entirely. Useful in revision and multi-ligament cases

Graft choice should take account of your sport, your occupation, whether you kneel regularly — relevant for many jobs and for prayer — and whether this is a first or a revision reconstruction.

What ACL reconstruction surgery involves

The procedure is arthroscopic, through two or three small incisions with a camera inside the joint. The graft is harvested and prepared, tunnels are drilled in the thigh bone and shin bone at the precise anatomical attachment points of the original ligament, and the graft is passed and fixed under appropriate tension.

Tunnel position is the single most important technical factor in ACL tear surgery in Faridabad or anywhere else. A graft placed non-anatomically will stretch, fail or restrict movement regardless of how well everything else is done. Any meniscus tears are repaired at the same time wherever repairable. Surgery takes 60 to 90 minutes and is usually a day case or single overnight stay.

ACL rehabilitation protocol — phase by phase

Phase 1 — Weeks 0 to 2

Control swelling, restore full extension — this is non-negotiable, as a knee that does not fully straighten early rarely does later — reactivate the quadriceps, weight-bear as comfort allows.

Phase 2 — Weeks 2 to 6

Full range of movement restored. Closed-chain strengthening begins. Normal walking pattern without aids. Stationary cycling.

Phase 3 — Weeks 6 to 12

Progressive resistance training, single-leg strength work, balance and proprioception. The graft is biologically at its weakest around this period — which is exactly when patients feel good and do too much.

Phase 4 — Months 3 to 6

Running reintroduced once strength criteria are met. Agility, cutting and plyometric work added progressively.

Phase 5 — Months 6 to 12

Sport-specific training and return to competition based on objective testing, not the calendar — quadriceps and hamstring strength within 90 per cent of the other leg, hop test symmetry, and psychological readiness. Returning before nine months substantially increases re-rupture risk.

Associated injuries we check for

  • Meniscus tears present in a large proportion of ACL injuries; repaired at the same operation where possible
  • Cartilage damage may need addressing alongside
  • MCL injury — usually heals with bracing before reconstruction
  • PCL and multi-ligament injury changes the surgical plan entirely
  • Bone bruising — common, usually resolves, but can prolong early symptoms

Frequently asked questions about ACL surgery

How soon after the injury should I have surgery?

Usually not immediately. Operating on a swollen, stiff knee increases the risk of post-operative stiffness. The standard approach is to settle the swelling and restore full movement first — typically two to six weeks — then reconstruct. The exception is a locked knee from a bucket-handle meniscus tear, which needs earlier surgery.

Can I live without an ACL?

Many people do, particularly those who are older or whose activities do not involve pivoting. The question is whether your knee gives way. Repeated instability damages the meniscus and cartilage and leads to earlier arthritis, so a knee that gives way should be reconstructed.

What is the success rate of ACL reconstruction?

Graft survival and restoration of stability are achieved in the large majority of patients. Return to the same level of competitive sport is lower — roughly two-thirds — and depends heavily on rehabilitation quality, age and psychological readiness.

Will I need a brace afterwards?

For an isolated ACL reconstruction, often not. Bracing is used when a meniscus repair or collateral ligament injury has been treated at the same time, where protected movement is needed.

Can the new ACL tear again?

Yes. Re-rupture risk is highest in young athletes returning to pivoting sport, particularly those who return before nine months or with persistent strength deficits. The opposite knee is also at increased risk, which is why rehabilitation addresses both legs.

What does ACL surgery cost in Faridabad?

It depends on the graft and fixation used, whether a meniscus or cartilage procedure is performed at the same time, and room category. Most insurance policies cover ACL reconstruction following injury. Bring your policy to the consultation for a written estimate.

Author & Medical Review

Medically reviewed by Dr. Sunil Choudhary, MBBS, MS, DNB, MRCS, FRCS (Tr & Orth).