Sports Injury Treatment in Mumbai (ACL and Meniscus Injuries)

Our Approach In Managing Sports Injuries (ACL, Meniscus)

Speed. Precision. Back in the Game.

At Shree Hospitals, we combine cutting-edge sports medicine with advanced arthroscopic surgical expertise to manage ACL tears and meniscus injuries in Mumbai at every level of severity.

Our multidisciplinary sports injury team comprising orthopaedic knee surgeons, sports medicine physicians, and certified sports physiotherapists treats each athlete as an individual, considering not just the injury itself but the sport, position, competitive level, and functional goals that define what full recovery means for that person.

When a patient presents with a suspected knee ligament injury or meniscus tear, our sports medicine specialists perform an immediate on-field-style clinical assessment alongside high-resolution MRI imaging.

This combination allows us to distinguish between an isolated ACL tear, a combined ACL and meniscus injury, a multi-ligament knee dislocation, or a purely cartilaginous meniscal lesion each of which has a fundamentally different treatment pathway and recovery timeline.

• High-resolution 1.5T MRI of the knee for ACL, meniscus, cartilage, and collateral ligament assessment
• Lachman test, anterior drawer, and pivot shift examination for ACL integrity grading
• McMurray, Thessaly, and joint line tenderness testing for meniscal pathology
• Varus and valgus stress testing for collateral ligament involvement
• Standing long-leg alignment X-rays for associated varus or valgus malalignment
• KT-1000 arthrometer measurement for objective ACL laxity quantification

Timely assessment and appropriate ACL tear treatment and meniscal injury management can help address knee instability and support joint function. Treatment recommendations depend on the type and severity of the injury, the patient's activity level and clinical assessment.

•  Patient-specific treatment plans based on injury pattern, age, sport, and activity level
• Anatomic ACL reconstruction using gold-standard graft options
• Meniscus preservation as the primary surgical philosophy repair over removal
• Sport-specific rehabilitation with objective return-to-play criteria
• Comprehensive follow-up including functional movement screening and MRI at 6 months

Our sports injury team treats athletes from school level to national representation  with the same standards of care applied to every patient, regardless of background.

1. Advanced Sports Injury Diagnosis & Knee Assessment

Accurate diagnosis is the foundation of every successful sports injury outcome. Not all knee injuries are the same, and the difference between an isolated ACL tear, a combined ACL-meniscus injury, or a multi-ligament disruption determines the entire treatment strategy.

• 1.5T MRI knee with dedicated sports injury protocol — visualising ACL fibre disruption, meniscal tear pattern, bone bruise, cartilage status, and collateral ligament integrity
• MRI arthrogram for complex chondral (cartilage) and subtle meniscal root tears
• Weight-bearing standing X-rays to assess joint space and limb alignment
• KT-1000 arthrometer testing for objective, reproducible anterior tibial translation measurement
• Pivot shift grading under examination under anaesthesia (EUA) at the time of surgery
• KOOS (Knee injury and Osteoarthritis Outcome Score) and IKDC scoring for functional baseline documentation
• Functional movement screening — landing mechanics, single-leg squat, and neuromuscular control assessment

This precise, multi-modal diagnostic approach eliminates ambiguity and ensures that every surgical plan is based on complete, accurate anatomical and functional data.

2. Non-Surgical Sports Injury Management

Not every ACL tear or meniscus injury requires surgery. For partial ACL tears, meniscal contusions, isolated low-grade collateral ligament injuries, and carefully selected complete ACL tears in older or low-demand patients, structured non-surgical management can achieve satisfactory outcomes.

• RICE Protocol & Early Swelling Management — Rest, Ice, Compression, and Elevation in the first 48–72 hours to control acute haemarthrosis and reduce joint inflammation.
• Crutches & Functional Bracing — Off-loading the injured knee while maintaining mobility; customised hinged knee braces for collateral ligament injuries.
• Physiotherapy & Neuromuscular Rehabilitation — Progressive quadriceps and hamstring strengthening, proprioceptive retraining, and dynamic knee stabilisation exercises — the cornerstone of conservative ACL management.
• Platelet-Rich Plasma (PRP) Injections — Autologous biologic therapy to accelerate soft tissue healing in partial ACL tears, meniscal contusions, and associated cartilage injuries.
• Hyaluronic Acid Injections — For associated chondral softening or early degenerative change in older athletes with meniscal pathology.
• Activity Modification & Sport-Specific Load Management — Gradual return-to-sport progression under physiotherapist supervision, with objective functional testing before clearance.

Conservative management is monitored with clinical reassessment and repeat MRI at 3 months. Patients with persistent instability, recurrent swelling, or functional limitation despite adequate rehabilitation are referred for surgical evaluation.

Conservative management is reassessed at 6–8 weeks. Persistent instability, ongoing pain, or failed non-surgical treatment after 3 months are indicators for surgical evaluation.

3. Arthroscopic ACL Reconstruction

ACL reconstruction is the gold standard treatment for complete ACL tears in active patients who wish to return to pivoting, cutting, or contact sports.

Our surgeons perform anatomic, single-bundle and double-bundle reconstructions using the graft options best suited to each patient's anatomy, age, and sport.

Graft Options:

• Hamstring Tendon Autograft (STG — Semitendinosus & Gracilis) — The most commonly used graft worldwide. Harvested from the patient's own hamstring tendons, quadrupled and fixed with adjustable cortical buttons. Minimal donor site morbidity and excellent long-term outcomes.
• Bone-Patellar Tendon-Bone (BPTB) Autograft — The historic gold standard, particularly favoured for high-level contact athletes. Bone-to-bone healing provides the fastest fixation strength and the lowest re-tear rate.
• Quadriceps Tendon Autograft — Increasingly popular for revision ACL surgery and patients with large grafts required. Avoids hamstring or patellar tendon harvest in cases where these are compromised.
• Allograft (Donor Tendon)—Used selectively in older, lower-demand patients or multi-ligament reconstructions where autograft tissue is insufficient.

Surgical Technique:

• Anatomic tunnel placement using the native ACL footprint as reference—restoring the ACL's natural oblique orientation for rotational stability
• All-inside technique for minimal tibial bone loss
• Double-bundle reconstruction (anteromedial + posterolateral bundle) for high-level athletes requiring maximum rotational control
• Concurrent lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction for high-grade pivot shift — significantly reduces re-tear risk in young athletes returning to sport

Combined Procedures (where indicated):

• Simultaneous meniscus repair during ACL reconstruction is strongly recommended, as meniscal preservation reduces long-term osteoarthritis risk
• Medial or lateral collateral ligament repair for multi-ligament knee injuries
• Microfracture or cartilage restoration procedures for associated chondral lesions

All ACL reconstructions at Shree Hospitals use intraoperative fluoroscopy and arthroscopic guidance to confirm anatomic tunnel placement before graft fixation.

4. Arthroscopic Meniscus Surgery (Repair & Meniscectomy)

The meniscus is not just a shock absorber; it is a critical load-sharing and joint-stabilising structure. Preserving as much meniscal tissue as possible is our primary surgical philosophy, because every millimetre of meniscus lost accelerates cartilage wear.

Meniscus Repair (Preservation):

• All-Inside Meniscal Repair—Suture-based devices (FasT-Fix, Meniscal Cinch) are inserted arthroscopically to approximate and secure the torn meniscal edges. No incisions required. Indicated for peripheral, vascular (red-red and red-white zone) tears — particularly in young patients and when performed simultaneously with ACL reconstruction.
• Inside-Out Meniscal Repair — Sutures are passed arthroscopically from inside the joint and tied over the capsule through a small accessory incision. Used for larger, complex posterior horn tears.
• Outside-In Repair — For anterior horn tears. Sutures are passed from outside-in and tied arthroscopically.
  Repaired menisci require 4–6 months for healing — during which weight-bearing and range of motion are carefully restricted according to repair zone and technique.

Partial Meniscectomy (When Repair is Not Possible):

• For degenerative or complex tears in the avascular zone that cannot be reliably repaired, the minimum amount of unstable meniscal tissue is resected arthroscopically, preserving the peripheral rim
• Preserving even a small rim of meniscal tissue maintains load distribution and delays joint degeneration
• Partial meniscectomy patients are typically mobilised the same day and return to sport in 4–8 weeks

Meniscal Root Repair:

• Meniscal root tears — equivalent biomechanically to a total meniscectomy — are repaired using trans-tibial pull-through suture technique to restore hoop stress and prevent rapid joint-space narrowing

Meniscal Allograft Transplantation:

• For patients who have undergone prior total or near-total meniscectomy and are developing medial or lateral compartment pain and early degeneration, a size-matched cadaveric meniscus allograft is transplanted arthroscopically to restore joint protection

5. Sports Rehabilitation & Return to Play

ACL reconstruction and meniscus surgery are not complete until the athlete has passed objective criteria for return to sport — not just a calendar date. Our sports rehabilitation programme is criteria-based, progressive, and sport-specific.

ACL Reconstruction Rehabilitation:

• Phase 1 (0–2 weeks): Swelling control, quad activation, full knee extension, partial weight-bearing
• Phase 2 (2–6 weeks): Full weight-bearing, stationary cycling, closed-chain strengthening
• Phase 3 (6–12 weeks): Running progression begins, single-leg balance, proprioception training
• Phase 4 (3–6 months): Sport-specific agility, change of direction, jumping and landing mechanics
• Phase 5 (6–9 months): Return-to-sport testing — limb symmetry index >90%, psychological readiness, sport-specific clearance
• Return to full contact training: typically 9–12 months post-surgery

Meniscus Repair Rehabilitation:

• 0–4 weeks: Non-weight-bearing, passive range-of-motion only
• 4–8 weeks: Partial weight-bearing, stationary cycling with low resistance
• 8–16 weeks: Full weight-bearing, progressive strengthening
• 4–6 months: Return to running and sport-specific training
• 5–6 months: Return to full sport

Objective Return-to-Play Criteria:

• Limb Symmetry Index (LSI) >90% on quadriceps and hamstring isokinetic testing
• Single-leg hop test symmetry >90%
• Y-Balance Test within normal limits
• Psychological readiness assessment (ACL-RSI score)
• Satisfactory pivot shift elimination on clinical examination

Our sports physiotherapy team uses validated functional testing protocols, not just time, to determine when an athlete is genuinely ready to return, minimising re-injury risk.