What should be checked before ACL surgery – is an MRI enough?
No – seeing an ACL tear on the MRI is not enough to plan ACL surgery. Dr Sankalp Pande explains that he first understands your current problem, your goals and the present condition of your knee, and looks at the clinical examination and MRI together for associated injuries. Only then is it decided whether surgery is appropriate and, if so, which graft and technique to use, with the recovery route planned alongside the operation.
Key points from the video
- An ACL tear on the MRI alone is not enough to plan surgery; your body structure, requirements and associated injuries need to be understood first.
- He first asks when and how the injury happened, whether it is a first or repeat injury, and which daily activities are now difficult.
- Your goals – desk job, heavy work, gym, running or sport, for enjoyment or competition – decide what level your knee has to recover to.
- The knee's swelling, movement, stability and muscle condition are assessed, and the clinical examination and MRI are looked at together.
- Injuries to the meniscus, cartilage or other ligaments are checked, because they can change both the surgical procedure and the recovery plan.
- It is then decided whether ACL surgery is appropriate and, if so, which graft, which technique and whether to repair the meniscus – each with a clear reason.
- Recovery is planned with the surgery and judged by your knee's condition, the surgery done and your progress, not by a fixed date.
Questions patients ask
Is an MRI enough to plan ACL surgery?
No. Dr Pande says surgery cannot be planned just by seeing an ACL tear on the MRI. Your body structure, requirements and associated injuries need to be understood first, and the clinical examination and MRI are looked at together.
What is asked about before ACL surgery is planned?
When and how the injury happened, whether it is a first or repeat injury, which activities are difficult, any brace, physiotherapy or other treatment so far, pain, swelling and balance, and your age, occupation and the physical demands of your work.
Why do other knee injuries matter when planning ACL surgery?
Injuries to the meniscus, cartilage or another ligament can change both the surgical procedure and the recovery plan. So he checks whether the meniscus can be repaired, the condition of the cartilage, and whether any other ligament is injured.
Is ACL recovery the same for every patient?
No. Recovery may be different if the meniscus or another ligament has been repaired. It is not viewed by a fixed date but by your knee's condition, the surgery done and your progress, with movement, stability and function checked at follow-up.
Transcript
Read the full transcript (English translation of the Hinglish video)
How do we plan ACL surgery in SAFE ACL? Can surgery be planned just by seeing an ACL tear on the MRI? No. Before planning ACL surgery, it is necessary to understand the patient's body structure, requirements and associated injuries. Hello friends, my name is Dr Sankalp Pande, I am a SAFE ACL surgeon. Today we will understand how ACL surgery is planned in SAFE ACL.
First of all, we understand the patient's current problem. When and how did the injury happen? Is this the first injury, or has the injury happened again? What activity is the patient having difficulty with now? Walking, using stairs, squatting, running or changing direction, driving or job, gym or sports?
Has the patient had a brace, physiotherapy or any other treatment so far? How much pain and swelling is there in the knee? How much difficulty is there in maintaining balance? What are the patient's age, occupation and the physical demands of the work? By understanding all this, we find out how the ACL is affecting the patient's daily life.
After this, we understand the patient's goals. What does the patient want to do after surgery? Is their goal to do routine activities comfortably, like office, a desk job or driving, or does the patient's job involve heavy work, or do they want to do jumping, gym or running again, or play sports like cricket, football, badminton again? If the patient wants to go back to sports, do they play for enjoyment or at a competitive level? How much running, jumping, landing and change of direction does their sport need? The patient's goal tells us to what level their knee has to recover after surgery.
Now we assess the current condition of the knee. How much swelling there is, how much movement, how stable it is, and what the muscle condition and current physical level are. After this, we look at the clinical examination and MRI together to understand the associated injuries.
Is only the ACL injured, or is the meniscus injured along with the ACL? Can the meniscus be repaired? What is the condition of the cartilage? Is there an injury to any other ligament too? Understanding associated injuries is important, because they can change both the surgical procedure and the recovery plan.
Now the patient's problem, their goals, current physical activities and associated injuries are put together. First, it is decided whether ACL surgery is appropriate for the patient or not. If surgery is needed, then which graft? Which surgical technique? Whether or not to repair the meniscus? Or is there an associated injury to address, such as another ligament injury? There should be a clear reason behind all these decisions.
In SAFE ACL, planning does not end with the operation. Along with the surgery, the route of recovery is also planned. When will the patient be able to walk without support? When will walking start? When will they be able to go back to stairs, office, driving, a two-wheeler? When should cycling, swimming, lower limb gym, running, and sports-specific training start? And if they want to go back to sports, when will they be able to?
Every patient's recovery is not the same. If the meniscus has been repaired or some other ligament has been repaired, then recovery may be different. So recovery is not viewed by a fixed date, but according to the condition of the patient's knee, what surgery was done, and their progress. At follow-up, movement, stability, function and recovery milestones are assessed regularly.
This is the basic concept of ACL surgery planning in SAFE ACL: first understand the patient, then understand their goals, then assess the injuries of the whole knee along with the ACL, and then make a complete recovery plan, from surgery to daily routine, running and return to sports. In SAFE ACL, the plan for safe surgery starts from the patient's current problem and continues till the recovery goal. In the next video, we will understand how we choose the graft and surgical technique in ACL surgery.
If you have any question about SAFE ACL or ACL surgery, then call us on the number given on the screen or in the description, or WhatsApp us your MRI report. Thank you.
Read next
Patient guide: Does an ACL Tear Need Surgery?
ACL and meniscus tear: what surgery and recovery should I expect?An ACL tear with a meniscus tear is treatable with one keyhole surgery that reconstructs the ACL and, where possible, repairs the meniscus, followed by step-by-step rehabilitation starting with knee exercises from day 1.
ACL tear with bucket handle meniscus tear: what happens now?An ACL tear with a bucket handle meniscus tear is treated with surgery: where possible, the torn meniscus is brought back into place and repaired while the ACL is reconstructed.
Partial ACL tear: does it need surgery?Not every partial ACL tear needs surgery.Consult Dr. Sankalp Pande
Consultations are at MediArbor Clinics & Diagnostics, M-21 Basement, Mandir Marg, Saket, New Delhi (Mon–Sat, 12–8 pm). Bring or WhatsApp your MRI report.
This video and page are for patient education and do not replace a consultation. Treatment is decided after examining your knee.