ACL & PCL Reconstruction in Pune | Deccan Hardikar Hospital

What is ACL & PCL Reconstruction and who offers it in Pune?

ACL & PCL reconstruction is surgery to restore knee stability after tears of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) — or both. It is indicated for patients with persistent knee instability, sports injuries, or high-energy trauma. Deccan Hardikar Hospital in Pune, Shivajinagar, offers arthroscopic ACL and PCL reconstruction as part of its orthopaedics programme, with a dedicated knee ligament team and NABH pre-accreditation.

The ACL controls forward movement and rotation of the knee; the PCL controls backward movement. Tears of either ligament — or both in combined injuries — can cause instability, pain, and long-term joint damage if untreated. Reconstruction replaces the torn ligament with a graft to restore normal knee mechanics and enable return to daily activity and sport.

Who needs ACL & PCL reconstruction surgery?

Reconstruction is recommended when clinical examination and MRI confirm significant ligament injury and the patient's activity level, age, or instability makes non-surgical management insufficient. Common indications include:

• Knee giving way during cutting, pivoting, or everyday activities following an ACL tear
• A sudden audible or felt "pop" at the time of injury with immediate swelling and loss of function
• Persistent posterior knee instability or pain after a PCL injury (e.g., dashboard injury in a road accident)
• Combined ACL and PCL tears from high-energy trauma, sports collisions, or complex knee dislocations
• Recurrent instability episodes causing secondary damage to the meniscus or cartilage
• Young or active adults who wish to return to sport or physically demanding work
• Chronic ligament deficiency with progressive joint deterioration on imaging
• Associated meniscal tears or cartilage injuries requiring simultaneous surgical management

Not every ligament injury requires surgery. Partial tears, low-demand patients, or those with specific health considerations may be managed conservatively. At Deccan Hardikar Hospital, each patient undergoes individualised clinical and imaging assessment before a treatment plan is finalised.

How is ACL & PCL reconstruction performed at Deccan Hardikar Hospital?

The surgical pathway at Deccan Hardikar Hospital, Shivajinagar, Pune follows a structured pre-operative, intra-operative, and post-operative protocol tailored to each patient's injury pattern and goals.

1. Pre-operative evaluation: Clinical examination (Lachman test, anterior/posterior drawer, pivot shift, posterior sag tests) combined with plain X-rays and MRI to characterise the tear, identify associated meniscal or cartilage injuries, and plan graft selection and tunnel placement.
2. Anaesthesia and patient positioning: Surgery is performed under spinal or general anaesthesia. The knee is positioned to allow full arthroscopic access.
3. Graft harvest: The chosen graft — most commonly hamstring tendon autograft (semitendinosus/gracilis) or bone–patellar tendon–bone (BPTB) autograft — is harvested through a small incision. For combined reconstructions, allograft may supplement autograft to avoid excessive donor-site morbidity.
4. Arthroscopic joint assessment: The arthroscope is introduced through small portals. The joint is inspected; any meniscal tears or cartilage damage are addressed (repair or partial meniscectomy) in the same sitting.
5. Tunnel creation and graft passage: Bone tunnels are drilled in the femur and tibia to replicate the anatomic course of the native ligament. The prepared graft is passed through the tunnels under arthroscopic visualisation.
6. Graft fixation: The graft is tensioned and secured with appropriate fixation devices (interference screws, cortical buttons, or hybrid fixation). PCL reconstruction may use a transtibial or tibial inlay technique depending on surgeon preference and anatomy.
7. Wound closure and dressing: Portals and harvest sites are closed. A compression bandage and knee brace are applied.
8. Post-operative monitoring: The patient is observed in the recovery area; pain management, ice, and elevation are initiated. Most patients are mobilised with crutches on the day of or the day after surgery.

For sports injury and arthroscopy cases, the team at Deccan Hardikar Hospital uses modern arthroscopic towers and imaging systems to ensure accurate tunnel placement and optimal graft fixation.

What are the surgical approaches for ACL & PCL reconstruction?

Arthroscopic reconstruction is the standard approach at Deccan Hardikar Hospital. Open surgery is reserved for selected complex or revision cases. The table below compares the two approaches and the main graft options available.

Graft selection is discussed in detail with each patient, weighing activity level, age, injury pattern, and personal goals. For combined ACL and PCL injuries, a combination of autograft and allograft is frequently used to provide adequate tissue while limiting donor-site morbidity.

What is the recovery timeline after ACL & PCL reconstruction?

Recovery is a graduated process. Timelines below are general guides; individual progression depends on injury complexity, graft choice, and rehabilitation adherence. Combined ACL and PCL reconstructions typically require longer protected phases than isolated reconstructions.

1. 0–2 weeks (immediate post-op): Pain control, ice, limb elevation, and protected weight-bearing with crutches. Passive range-of-motion exercises begin under physiotherapy guidance to prevent stiffness.
2. 2–6 weeks (early rehabilitation): Gradual increase in weight-bearing as tolerated. Active quadriceps and hamstring strengthening commences. Gait normalisation and continued swelling management.
3. 6–16 weeks (strength and neuromuscular phase): Progressive resistance training, balance and proprioception exercises, low-impact cardiovascular conditioning (stationary cycling, hydrotherapy).
4. 4–6 months (advanced training): Sport-specific drills, plyometrics, and agility work introduced. Formal return-to-sport criteria testing begins around 6 months for isolated ACL reconstruction.
5. 6–9 months (return to sport — ACL): Many athletes return to competitive sport in this window following isolated ACL reconstruction, subject to passing functional testing.
6. 9–12+ months (full confidence and performance): Full performance and psychological readiness may take up to 12 months or longer, particularly for combined ACL and PCL cases or high-demand sports.

For detailed guidance on joint care and rehabilitation following knee surgery, speak with the orthopaedic team at Deccan Hardikar Hospital.

What are the risks and considerations of ACL & PCL reconstruction?

ACL and PCL reconstruction are well-established procedures; however, as with all surgery, there are recognised risks that patients should understand before consenting to treatment. The surgical team at Deccan Hardikar Hospital discusses these in detail during pre-operative consultation.

• Graft failure or re-rupture: The reconstructed ligament can re-tear, particularly in young athletes returning to high-demand sport. Risk is influenced by graft choice, surgical technique, and rehabilitation compliance.
• Infection: As with any surgical procedure, superficial or deep joint infection is possible, though uncommon with arthroscopic techniques and standard prophylaxis.
• Stiffness (arthrofibrosis): Excessive scar tissue formation can limit range of motion; early physiotherapy is key to prevention.
• Donor-site morbidity: Harvest of autograft tissue (hamstring, patellar tendon, quadriceps) can cause localised pain, weakness, or sensory changes at the harvest site.
• Nerve or vascular injury: Rare but possible; the saphenous nerve is at risk during hamstring harvest. PCL reconstruction carries a small risk to popliteal neurovascular structures.
• Deep vein thrombosis (DVT): Blood clot formation in the leg veins is a recognised risk after knee surgery; prophylactic measures are routinely employed.
• Persistent pain or instability: A proportion of patients may experience ongoing symptoms despite technically successful surgery, particularly if associated injuries (meniscal, cartilage) were not addressed.
• Anaesthetic risks: Standard risks associated with spinal or general anaesthesia apply and are assessed pre-operatively.

Patients with combined ACL and PCL injuries face a more complex surgical and rehabilitation course, with a higher likelihood of residual symptoms compared to isolated reconstructions. Honest pre-operative counselling is a priority at Deccan Hardikar Hospital.

Which surgeons perform ACL & PCL reconstruction at Deccan Hardikar Hospital?

ACL and PCL reconstruction at Deccan Hardikar Hospital in Pune is performed by a team of qualified orthopaedic surgeons with credentials in knee ligament and sports surgery. Patients are assessed and managed by the most appropriate specialist based on their injury profile.

The hospital is NABH pre-accredited and recognised by the Quality Council of India, reflecting its commitment to clinical standards and patient safety across all orthopaedic procedures including sports injury and arthroscopy.