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Clinical Case Study

ACL Reconstruction Surgery

Complete ACL Tear with Medial Meniscus Involvement β€” Grade 3

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24-Year-Old Male, Cricket Player
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Delhi, India
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Apollomedics, Lucknow
24 Patient Age
Male, Cricket Player
7 mo Return to Sport
Competitive Cricket
Grade 3 ACL Tear Severity
+ Meniscus Involvement
65 min Operation Time
Arthroscopic Surgery
Day 1 Discharged
Next Day After Surgery
18 mo Follow-Up
Zero Re-Injury
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Patient Background & Presentation

The patient was a 24-year-old male competitive cricket player from Delhi. He had been playing cricket since childhood and was a regular member of a local club team. During a high-intensity match, while attempting a quick single run, he planted his right foot awkwardly and twisted his knee. He immediately heard and felt a loud 'pop' inside his knee, followed by intense pain and a sudden feeling of instability β€” as if the knee had given way completely.

Within minutes, significant swelling developed around the joint. The patient was unable to continue playing and required assistance to leave the field. Over the next 24 hours, the swelling increased further, the knee became stiff and painful to bend, and he was unable to bear his full body weight without support.

He initially consulted a local doctor in Delhi who suggested rest, ice, and painkillers. After two weeks with minimal improvement, the patient was referred for an MRI scan. The MRI results alarmed him β€” he was told he likely needed surgery but was uncertain about who to trust and where to go for treatment that would actually get him back to cricket.


Patient DetailClinical Information
Age24 Years
GenderMale
OccupationCompetitive Cricket Player
CityDelhi, India
Dominant LimbRight
Affected KneeRight Knee
Duration of Symptoms3 Weeks Before Consultation
Previous TreatmentRest, Ice, Painkillers Only
Main ConcernReturn to Competitive Cricket
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How the Patient Found Dr. Kamal Kishor Gupta

After receiving his MRI report, the patient searched online for an expert opinion on ACL Reconstruction Surgery in Lucknow and found Dr. Kamal Kishor Gupta, Senior Orthopedic Surgeon at Apollomedics Super Speciality Hospital, Lucknow. He was specifically looking for a doctor who was not just experienced in knee surgery but who had a dedicated background in sports medicine β€” someone who would understand the pressures of returning to competitive sport, not just walking normally.

Dr. Gupta's profile stood out for several reasons: his FIFA Medical Diploma from Barcelona (the same qualification held by doctors who treat professional football players worldwide), his Fellowship in Arthroscopy & Arthroplasty from Singapore General Hospital, and his MRCS qualification from the Royal College of Surgeons, Edinburgh. These international qualifications, combined with over 580 five-star Google reviews and a 4.9-star rating, gave the patient confidence.

Most importantly, the patient discovered that Dr. Gupta offers a free MRI review service via WhatsApp β€” patients from anywhere in India can send their scans and receive a personal clinical assessment within 24 to 48 hours, without any fee or registration.

I did not want to travel all the way to Lucknow and then be told something I already knew. Dr. Gupta's WhatsApp review saved me time and gave me real answers before I even left Delhi.

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MRI Review & Clinical Diagnosis

The patient photographed his MRI films and shared them with Dr. Kamal Kishor Gupta via WhatsApp. Within 36 hours, Dr. Gupta personally reviewed the scans and responded with a clear, detailed explanation β€” in plain language, not complicated medical terms.


Complete ACL Tear β€” Grade 3
The ACL ligament was fully torn with no continuity remaining. The knee was unstable and could not heal on its own without surgery.
Partial Medial Meniscus Tear
The medial meniscus had a partial tear β€” this needed to be addressed at the same time as the ACL to avoid a second surgery.
Bone Bruising (Bone Contusion)
Impact bruising visible on the lateral femoral condyle and tibial plateau β€” typical of an ACL injury mechanism. No fractures present.
Joint Effusion (Swelling)
Significant fluid accumulation inside the joint was confirmed, consistent with acute ligament injury.
No PCL or LCL Involvement
The posterior cruciate ligament and lateral collateral ligament were intact β€” confirming this was an isolated ACL + meniscus injury.
Key Advantage: Because the meniscus tear was identified and planned for upfront, both the ACL reconstruction and the meniscus repair were completed in a single 65-minute procedure β€” avoiding two separate surgeries.
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Pre-Operative Phase β€” 3 Weeks Before Surgery

A critical and often overlooked part of ACL surgery is what happens before the operation. Dr. Gupta prescribed a structured 3-week pre-operative physiotherapy programme before scheduling surgery. This approach β€” called 'prehabilitation' β€” is well-established in sports medicine but is not followed by all surgeons.


  • 01
    Reduce Joint Swelling
    Swelling stiffens the knee and weakens the muscles around it. Reducing it before surgery makes the operation technically easier and recovery smoother.
  • 02
    Restore Quadriceps Activation
    After an ACL tear, the brain partially 'switches off' the quadriceps muscle as a protective reflex. Restoring this neuromuscular connection is essential before surgery.
  • 03
    Maintain Full Range of Motion
    Losing extension before surgery makes it very hard to regain after. The physiotherapy prevented this.
  • 04
    Psychologically Prepare the Patient
    The programme helped the patient understand his knee, feel more in control, and arrive at surgery with a positive, active mindset β€” which research shows improves outcomes.
  • 05
    Reduce Risk of Post-Op Stiffness
    Entering surgery with a stiff knee dramatically increases the risk of post-operative stiffness (arthrofibrosis). Pre-op physio minimised this risk.
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Arthroscopic ACL Reconstruction β€” Procedure in Detail

The surgery was performed at Apollomedics Super Speciality Hospital, Lucknow. Dr. Kamal Kishor Gupta performed the operation using a fully arthroscopic (keyhole) technique. Spinal anaesthesia combined with a femoral and sciatic nerve block was used β€” avoiding general anaesthesia, reducing nausea, and providing excellent pain control for 12–18 hours post-surgery.

For a 24-year-old competitive athlete, Dr. Gupta selected a hamstring graft (semitendinosus + gracilis tendons) β€” approximately 8.5mm diameter β€” before the arthroscopic reconstruction began.


01
Arthroscopic Assessment
Three small keyhole incisions (portals) were made around the knee. A tiny camera was inserted to directly visualise the inside of the joint. Dr. Gupta confirmed the MRI findings: complete ACL tear and partial medial meniscus tear. The joint was thoroughly assessed for any additional damage.
02
Meniscus Repair β€” First
The medial meniscus tear was repaired arthroscopically using an inside-out suture technique. Preserving the meniscus is critical β€” it acts as a shock absorber and protects the knee from developing arthritis in later life. Removing it would have increased the patient's risk of long-term knee damage significantly.
03
Tibial Tunnel Creation
A precisely angled guide was used to drill a bone tunnel through the tibia (shin bone). The position and angle of this tunnel are critically important β€” a poorly placed tunnel is the most common cause of ACL reconstruction failure. Dr. Gupta used anatomic tunnel placement to match the natural ACL footprint.
04
Femoral Tunnel Creation
A second tunnel was drilled through the femur at the anatomic ACL attachment site using an anteromedial portal technique β€” allowing a more vertical and anatomically accurate tunnel position compared to older techniques, resulting in better rotational stability of the knee.
05
Graft Passage & Fixation
The hamstring graft was passed through the tibial and femoral tunnels. Fixed at the femoral side using a cortical button (Endobutton) and at the tibial side using a bioabsorbable interference screw. The graft was tensioned at 30Β° of knee flexion to replicate the natural resting tension of the ACL.
06
Final Arthroscopic Check
Dr. Gupta performed a Lachman test and Pivot Shift test under direct arthroscopic vision to confirm full stability restoration. Range of motion checked β€” the knee achieved full extension and 130Β° of flexion on the table. Portals closed and compression bandage applied.

Both the ACL and the meniscus were repaired in a single 65-minute arthroscopic procedure. No additional incisions. No second surgery. Back to the ward the same day.


ProcedureACL Reconstruction + Meniscus Repair
Graft TypeAutologous Hamstring (Semitendinosus + Gracilis)
Graft Diameter~8.5mm
Femoral FixationCortical Button (Endobutton)
Tibial FixationBioabsorbable Interference Screw
Tunnel TechniqueAnatomic β€” Anteromedial Portal
AnaesthesiaSpinal + Peripheral Nerve Block
Total OT Time65 Minutes
Meniscus RepairInside-Out Suture Technique
DischargeDay 1 Post-Surgery
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Post-Operative Rehabilitation β€” Phase by Phase

Rehabilitation after ACL reconstruction is just as important as the surgery itself. Dr. Kamal Kishor Gupta designed a personalised, cricket-specific rehabilitation protocol for this patient β€” structured in four phases over 7 months.


Phase 1 Weeks 1–2: Protection & Swelling Control
Immediately after surgery, the focus is on protecting the repair, controlling pain and swelling, and beginning very gentle movement. The patient was given a hinged knee brace locked in extension for the first week. He began walking with crutches on the day of discharge. Ice packs, elevation, and compression bandages were used to manage swelling. Straight-leg raises and ankle pumps were started on Day 1 to prevent muscle wasting and blood clots.
Phase 2 Weeks 3–6: Early Mobility & Muscle Activation
The brace was gradually unlocked to allow increasing range of motion. Closed-chain exercises (like mini squats and leg press) were introduced β€” these strengthen the quadriceps without putting stress on the healing graft. Proprioception (balance and body awareness) training began using wobble boards. By Week 6, the patient was walking brace-free with a normal gait pattern.
Phase 3 Weeks 7–16: Strength Building & Jogging
This phase focused on building quadriceps and hamstring strength to at least 70% of the unaffected leg. Progressive resistance training, cycling, and swimming were the primary exercises. At 12 weeks, the patient began a return-to-running programme β€” starting with brisk walking, progressing to light jogging on a straight track. Strength testing using a dynamometer confirmed adequate symmetry before jogging was cleared.
Phase 4 Months 4–7: Sport-Specific Training & Return to Cricket
At 5 months, cricket-specific drills began: lateral movements, direction changes, batting footwork, fielding dives, and bowling run-ups. Each drill was introduced progressively based on the patient's strength and confidence. A formal return-to-sport assessment at 6.5 months β€” including single-leg hop tests and psychological readiness scores β€” confirmed the patient was ready. He returned to full competitive cricket at 7 months post-surgery.

Return-to-Sport Test / CriterionResult at Clearance
Quadriceps Limb Symmetry Index (LSI)βœ“ 94% β€” Passed
Hamstring Limb Symmetry Index (LSI)βœ“ 93% β€” Passed
Single-Leg Hop Test (for distance)βœ“ Passed
Triple Hop Testβœ“ Passed
Side-Step Agility Testβœ“ Passed
Pivot / Rotational Stress Testβœ“ Negative β€” No Instability
Full Range of Motion0°–135Β° (Normal, Symmetric)
Psychological Readiness (ACL-RSI Score)Score > 75 β€” Cleared
Pain During Sport DrillsNone Reported
Dr. Gupta Clinical Sign-Offβœ… Cleared for Full Competitive Play
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Clinical Outcomes & Follow-Up

0°–135Β° Range of Motion Full & Symmetric
94% Quad Symmetry Limb Symmetry Index
Zero Re-Injury At 18-Month Follow-Up
TimelineOutcome
Day 1 Post-SurgeryDischarged home walking with crutches and brace
Week 2Swelling controlled, knee ROM 0°–90Β°, straight leg raises achieved
Week 6Walking brace-free with normal gait, no pain at rest
Week 12Jogging commenced on straight track, strength testing passed
Month 5Cricket-specific footwork and fielding drills commenced
Month 6.5Formal return-to-sport testing β€” all criteria met
Month 7Returned to full competitive cricket β€” first match played
Month 18Follow-up MRI and clinical review β€” graft intact, full function, no re-injury

Patient returned to competitive cricket at 7 months post-surgery with full range of motion and no re-injury on follow-up at 18 months. Graft integrity confirmed on MRI.

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Key Clinical Decisions That Made the Difference

This case demonstrates several important clinical decisions that contributed to the successful outcome. Each reflects Dr. Gupta's training in international sports medicine and his understanding of what young athletes need to return to sport safely.


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Free Remote MRI Review
By offering a WhatsApp-based MRI review before the patient travelled to Lucknow, Dr. Gupta was able to diagnose the injury accurately, plan for both the ACL and meniscus repair together, and advise on the correct pre-operative preparation. This prevented wasted time and unnecessary consultations.
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Pre-Operative Physiotherapy
Many surgeons operate as soon as the patient arrives. Dr. Gupta's decision to wait 3 weeks for prehabilitation is evidence-based and significantly improves post-operative outcomes. Studies consistently show that patients who enter ACL surgery with full extension and good quad strength recover faster.
🦡
Meniscus Preservation
Rather than removing the torn meniscus (meniscectomy) β€” which is quicker and easier β€” Dr. Gupta repaired it. Meniscus preservation is technically more demanding but dramatically reduces the patient's risk of developing knee arthritis in the following decades. For a 24-year-old athlete, this is the right long-term decision.
🎯
Anatomic Tunnel Placement
Using the anteromedial portal technique for femoral tunnel creation allowed Dr. Gupta to place the graft in an anatomically correct position. This restores both the straight-line stability (Lachman test) and the rotational stability (Pivot Shift) of the knee β€” both essential for cricket.
🏏
Phased, Sport-Specific Rehab
Dr. Gupta's cricket-specific protocol β€” with batting footwork, fielding dives, and bowling run-up drills β€” ensured the patient's knee was tested and prepared for the exact movements required in his sport, not just walking on a treadmill.
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Objective Return-to-Sport Testing
The decision to return to cricket was based on objective test results β€” limb symmetry indices, hop tests, and clinical examination β€” not just the passage of time. This evidence-based approach protects the patient from re-injury and ensures the graft is genuinely ready for competitive loads.
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About Dr. Kamal Kishor Gupta

Dr. Kamal Kishor Gupta
Senior Consultant Orthopedic Surgeon Β· Apollomedics Super Speciality Hospital, Lucknow
MBBSIndia
MS OrthopaedicsMaster of Surgery, India
FIAA β€” Fellowship in Arthroplasty & ArthroscopySingapore General Hospital, Singapore
MRCS β€” Member of Royal College of SurgeonsRoyal College of Surgeons, Edinburgh, UK
FIFA Medical Diploma in Sports MedicineBarcelona, Spain
Clinical Experience12+ Years
Previous HospitalsSingapore General Hospital; Fortis Escorts, Faridabad
Google Reviews580+ Reviews | 4.9-Star Average
ACL Reconstruction Total Knee Replacement Meniscus Repair Shoulder Surgery Sports Injury Management High Tibial Osteotomy GFC / PRP Therapy Cartilage Restoration
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Apollomedics Super Speciality Hospital, Lucknow

Dr. Gupta practices at Apollomedics Super Speciality Hospital β€” one of North India's most advanced tertiary care hospitals. Patients from Delhi, Kanpur, Varanasi, Gorakhpur, Agra, and across India regularly travel to Lucknow for treatment.


Dedicated Orthopaedic OT
Purpose-built laminar flow operating theatre for bone and joint surgery
Robotic Surgery Suite
Advanced robotic assistance for joint replacement procedures
Digital Imaging & MRI
On-site high-resolution MRI and digital X-ray for rapid diagnosis
Physiotherapy Unit
Dedicated post-operative rehabilitation on site
Rapid Recovery Ward
Same-day mobilisation protocol for eligible patients
Address
Kanpur–Lucknow Rd, Sector B, Bargawan, LDA Colony, Lucknow, UP 226012

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