5,000+ patients guided through treatment in Delhi NCREvery case read by a US board-certified physicianWritten opinion with costs within 48 hoursNABH and JCI accredited hospitals onlyArabic, English, Russian and Bengali spokenOur fees are published — hospitals pay us, not youMedical visa invitation letters for eight countries
TIB HIND

If your knee is locked and cannot be straightened, or you cannot bear weight after an injury, seek care today. A locked knee may indicate a displaced meniscal fragment needing prompt treatment. Also seek urgent care for a hot swollen knee with fever.

Home  /  Treatments  /  Joint replacement  /  ACL and meniscus injuries

ACL and meniscus injuries

Two of the commonest knee injuries, and two where surgery is performed more often than the evidence supports. Both deserve a careful decision rather than an automatic operation.

A torn ACL does not oblige everyone to have surgery, and a degenerate meniscal tear in an older knee usually should not be operated on at all. This page explains where surgery genuinely helps.

Clinically reviewed by Dr. Annie Varughese, Consultant Orthopaedic Surgeon Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
ACL surgery
Not for everyone
Depends on instability and activity, not the scan
Meniscus
Repair beats removal
Where the tear is repairable
Degenerate tears
Usually not surgical
Arthroscopy adds little in an arthritic knee
Time in India
10 to 14 days
Rehabilitation continues for months at home
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What these injuries are

The anterior cruciate ligament runs through the centre of the knee and prevents the shin bone from sliding forward and from rotating excessively on the thigh bone. It usually tears during a twisting movement with the foot planted — a pivot, a landing, a tackle — often with an audible pop, immediate swelling, and a sense that the knee has given way.

The menisci are two C-shaped cartilage pads that spread load across the joint and act as shock absorbers. They tear either acutely with a twisting injury in a young knee, or gradually through degeneration in an older one. These two situations are entirely different problems that happen to share a name.

Losing meniscal tissue matters more than was once appreciated. A knee that has had a large portion of its meniscus removed develops arthritis considerably earlier, which is why modern practice preserves and repairs the meniscus wherever possible rather than trimming it away.

The key question with an ACL tear is not whether it is torn but whether your knee is unstable. Many people with a completely torn ACL function well with strong muscles and activity modification. Others give way repeatedly, damaging the meniscus and cartilage with each episode. The second group needs reconstruction; the first often does not.

Symptoms

Symptoms and warning signs

Common symptoms
  • A pop or crack at the moment of injury, with rapid swelling
  • The knee giving way on turning or on uneven ground
  • Locking, or inability to fully straighten the knee
  • Pain along the joint line, inner or outer
  • Swelling after activity
  • Clicking or catching sensations
  • Loss of confidence in the knee on stairs or slopes
Warning signs of an emergency
  • Knee locked and cannot be straightened
  • Unable to bear any weight after injury
  • Obvious deformity after injury
  • Hot swollen knee with fever
  • Numbness or coldness in the foot after injury
  • Severe calf pain and swelling

An arthroscopy for a degenerate meniscal tear in an arthritic knee rarely helps

This is one of the clearest findings in orthopaedic research of the last fifteen years. In middle-aged and older patients with knee pain, a degenerate meniscal tear on MRI, and underlying arthritis, keyhole surgery to trim the meniscus gives results no better than a proper course of physiotherapy. It remains one of the most frequently performed unnecessary operations worldwide. If arthroscopy has been recommended for a degenerate tear in an arthritic knee, ask what evidence supports it in your case.

Diagnosis

How it is diagnosed

Examination tells more than most people expect, and MRI confirms rather than decides.

Initial tests

  • Clinical examination — Lachman and pivot shift tests for the ACL, joint line tenderness and McMurray for the meniscus
  • X-rays — exclude fracture and, importantly, assess whether arthritis is present
  • MRI — confirms the ligament and meniscal injury and shows associated damage
  • Assessment of instability in daily life — how often the knee actually gives way, which decides ACL treatment

The deciding tests

  • Standing X-ray — arthritis changes the whole approach and cannot be assessed on a lying film
  • MRI assessment of tear pattern and location — determines whether a meniscal tear is repairable
  • Long-leg alignment — where malalignment contributes, correction may be needed alongside
  • Muscle strength assessment — quadriceps strength before surgery predicts the outcome after it

Tell us how often the knee actually gives way

For an ACL injury this single piece of information matters more than the MRI. A knee that gives way weekly during ordinary activity needs reconstruction. A knee that has never given way since the initial injury, in someone who does not play pivoting sport, often does not. Describe what you can and cannot do, and what happens when you turn quickly.

Options

Treatment options

For both injuries, the right answer is frequently rehabilitation rather than surgery.

Option one

Structured rehabilitation

A supervised programme focusing on quadriceps and hamstring strength, balance and neuromuscular control. For many ACL-deficient knees this restores functional stability without surgery, and for degenerate meniscal tears it outperforms arthroscopy. It is also required before ACL reconstruction — operating on a stiff, weak knee produces a poor result.

Usually appropriate whenACL tear without significant instability, degenerate meniscal tear, and as preparation before any ACL surgery.
Option two

ACL reconstruction

The torn ligament is replaced with a graft taken from your own hamstring or patellar tendon, passed through tunnels drilled in the bone. It is keyhole surgery, usually a day case or one night. The operation is the smaller part of the process — the result is determined by nine months of rehabilitation afterwards.

Usually appropriate whenRecurrent giving way affecting daily life, or a wish to return to pivoting sport, in a knee without significant arthritis.
Option three

Meniscal repair

The torn meniscus is stitched back together rather than trimmed away, preserving the tissue that protects the joint from arthritis. It is possible where the tear is in the outer, blood-supplied zone and the tissue is healthy. Recovery is slower than after trimming — several weeks of restricted weight bearing — but the long-term joint protection is worth it.

Usually appropriate whenAn acute tear in the peripheral vascular zone, typically in a younger patient, particularly alongside ACL reconstruction.
Option four

Partial meniscectomy

Trimming away the torn fragment. It relieves mechanical symptoms such as true locking quickly, but it removes tissue permanently and accelerates later arthritis. It is appropriate for a genuinely irreparable tear causing mechanical symptoms — not for pain in an arthritic knee.

Usually appropriate whenAn irreparable tear causing true locking or catching, in a knee without established arthritis.
The decision

How the choice is made

Instability, not the scan

For ACL injuries, whether the knee gives way in real life decides the operation. An MRI showing a torn ACL in a stable knee is not by itself an indication for surgery.

Is the meniscal tear repairable

Tear pattern, location and tissue quality decide. Preserving meniscus protects the knee for decades and is worth a slower recovery.

Is there arthritis

Established arthritis changes everything. Arthroscopy for a degenerate tear in an arthritic knee is unlikely to help, and the conversation should be about arthritis management instead.

If your X-ray shows arthritis and your MRI shows a degenerate meniscal tear, we will recommend physiotherapy rather than an arthroscopy — and we will explain why.

Urgency

How urgent is your case

Usually safe to plan travel
  • Stable knee, planning elective reconstruction
  • Full range of movement restored after injury
  • No locking
  • Rehabilitation completed before surgery
Needs local assessment before travel
  • Knee locked and cannot straighten
  • Unable to bear weight after acute injury
  • Hot swollen knee with fever
  • Significant swelling and stiffness immediately after injury
  • Numbness or circulation problems in the foot

We will tell you which column you are in

ACL reconstruction is rarely urgent and is generally better performed once swelling has settled and movement is restored. A truly locked knee is different and needs assessment promptly.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • MRI report of the knee
  • X-rays, ideally standing
  • How often the knee gives way and during what activity
  • Date and mechanism of the original injury

Also helpful

  • Details of physiotherapy already completed
  • Your age and activity level, including any sport
  • Any previous knee surgery
  • Current range of movement and swelling
Send my reports for review See published cost ranges
Questions

Questions patients ask

Not necessarily. A substantial proportion of people with a completely torn ACL function well without surgery, particularly if they do not play pivoting sports and can build strong quadriceps and hamstrings. Reconstruction is indicated when the knee gives way repeatedly in daily life, because each episode risks further damage to the meniscus and cartilage. The instability, not the MRI, decides.

Repaired wherever it is possible. Removing meniscal tissue accelerates arthritis by years, and this is now well established. Repair requires the tear to be in the outer zone with a blood supply and the tissue to be healthy, and it demands a slower rehabilitation. Ask the surgeon specifically whether repair was attempted or considered.

Probably not. Degenerate meniscal tears are extremely common in middle-aged knees and are often found alongside arthritis that is the real source of pain. Multiple trials have shown arthroscopy in this situation gives no better results than physiotherapy. If you have true mechanical locking that is a different matter, but pain alone usually is not an indication.

The operation is straightforward but the rehabilitation is long. Walking without crutches within two to three weeks, straight-line running at around three months, and return to pivoting sport typically at nine to twelve months with proper testing. Returning early is the commonest cause of re-rupture. Only the first two weeks need to be in India.

Hamstring and patellar tendon grafts both have good long-term results with different trade-offs — patellar tendon may give slightly better stability but more kneeling discomfort, hamstring avoids that but may be marginally less stable in very high-demand athletes. Your surgeon's familiarity matters more than the choice itself. Ask which they use most and why.

Yes, and it is common. Repairing a meniscal tear at the same time as reconstructing the ACL gives the repair a better healing environment. It does extend the rehabilitation, particularly the period of restricted weight bearing, so plan for that.

RelatedOn this site
Joint replacement in IndiaRead → Knee osteoarthritisRead → Joint replacement costRead → Rotator cuff and shoulderRead → All treatmentsRead →
Contact

Send us your reports

Send the MRI report and standing X-rays, and tell us how often the knee gives way and during what activity. That last detail decides more than the scan.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

WhatsApp +91 83035 86344  ·  Phone +91 83035 86344  ·  Email tibhind@gmail.com

Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.