ENA pop in the knee after a bad twist playing football or skiing, swelling by the evening, then a knee that gives way when walking: these are typical signs of a torn anterior cruciate ligament (ACL). Or the story is different: years of knee pain until a doctor mentions surgery.
Knee operations solve different problems: they replace a torn ligament, repair a meniscus, restore cartilage, correct leg alignment or replace a worn joint. The choice depends on the damage, age and activity: a torn ligament in a young footballer and a worn joint in an older person call for different things. Below: which operations exist, ACL surgery in more detail and what the hospital estimate covers. Readers without a diagnosis should start with the page on knee pain.
Which operations are done on the knee
Operations on the knee deal with ligaments, menisci, cartilage, leg alignment and the joint as a whole, and each problem has its own operation. A torn ligament is replaced with a new one: this is reconstruction. A meniscus, the cartilage cushion between the bones, is stitched or partly removed. In cartilage, the damaged area is repaired. A misaligned leg is corrected by osteotomy: the bone near the knee is carefully cut and fixed at a new angle to take load off the worn side. When the whole joint is worn, it is partly or totally replaced.
Apart from joint replacement, most of these procedures are done arthroscopically: through a few small incisions the surgeon inserts a camera and fine instruments into the joint and operates while watching a screen.
ACL surgery in Germany
ACL surgery in Germany usually means reconstruction: the torn ligament is replaced with a new one, but not everyone needs it. The ACL connects the thigh bone to the shin bone, stops the shin from sliding forward and keeps the knee stable when turning. It runs inside the joint, bathed in joint fluid, and no blood clot forms at the tear, the kind of clot on which ligaments outside the joint heal; so the torn ends do not grow back together on their own. With low demands, without sports involving sudden turns, muscle training is sometimes enough: the thigh muscles take over part of the ligament’s work.
The new ligament is made from the patient’s own tendon: the hamstring tendons at the back of the thigh, the patellar tendon or the quadriceps tendon. The graft is passed through tunnels drilled in the thigh and shin bones and fixed there, for example with screws; which graft to use is the surgeon’s choice. The German guideline on ACL rupture (in German only) is being revised: its previous version has expired, and the German Society for Orthopaedics and Trauma Surgery (DGOU) is preparing a new one.
Rehabilitation takes months: the body gradually remodels the transplanted tendon into a new ligament, and the thigh muscles have to regain their strength. Return to sport is decided by tests, not by the calendar. How recovery after injuries and operations is organised is explained on the page on orthopaedic rehabilitation.
Meniscus, cartilage and realignment
The meniscus is preserved and stitched where possible, especially in younger patients. Its outer part, which has a blood supply, heals best; where stitching is not possible, only the damaged part is removed. Cartilage procedures, which restore an area of the joint surface, are for limited defects, not for wear of the whole joint.
Osteotomy suits active people with wear on one side of the joint, usually the inner side, and a misaligned leg: once the alignment is corrected, the load shifts to the healthy side. For them it is a way to postpone joint replacement.
When the joint is replaced instead
When wear is advanced, an artificial joint is discussed: a partial implant replaces only the worn compartment of the knee, a total implant replaces the joint surfaces of the thigh and shin bones. How the implant is chosen and how the operation goes is covered on the knee replacement page.
The hospital states the price in its estimate (Kostenvoranschlag), which covers assessment, the operation, the implant and the days in hospital. How the bill for a new knee joint is made up and what drives it is explained on the page on knee replacement cost.
Frequently asked questions
Can a torn ACL be treated without surgery?
Sometimes, yes. Without surgery the knee is strengthened with muscle training, so that the muscles take over part of the ligament’s work, and for people who avoid sports with sudden turns this can be enough. The decision depends on how unstable the knee is, whether the meniscus or other structures are injured and what the person expects the knee to do. If it keeps giving way, surgery can follow later, and that is not unusual.
Which graft is best for ACL reconstruction?
There is no single best graft. According to reviews of studies, hamstring, patellar and quadriceps tendon grafts give similar results: the knee is about equally stable, and re-tears and complications occur about as often. So the surgeon chooses for the individual patient, taking into account the sport, injuries to other ligaments, previous knee operations and his or her own experience.
When can I return to sport after ACL surgery?
When the knee passes the tests, not after a fixed period. The doctor and physiotherapist check that training causes no pain or feeling of instability, that the exercises of the person’s sport are performed cleanly and how close the strength of the operated leg has come to the healthy one. How long this takes cannot be predicted exactly: rehabilitation takes months in any case, and the return to ball sports with sudden turns comes later than to lighter activity.
How AlenMed arranges knee surgery
AlenMed has the reports and a description of the injury translated and sends them with the MRI on disc to surgeons who operate on the knee. One of these surgeons is Dr Matthias Hoppert, Director of the Department of Orthopaedics and Trauma Surgery at ISAR Klinikum and a certified knee surgeon of the German specialist societies.
AlenMed then requests the hospital’s estimate and the visa invitation and arranges an interpreter for consultations, and before leaving the patient receives a rehabilitation plan to continue at home. AlenMed’s office is in Munich; partner hospitals are all over Germany.
This material is for reference only and is not an offer. The treatment approach is decided by a doctor after an in-person examination.
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