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ACL Tear Surgery - Diagnosis & Recovery

Anterior cruciate ligament (ACL) tear commonly occurs in people who have an active lifestyle and play physical sports. ACL tear does not heal on its own and needs prompt treatment to restore normal function. If you are looking for the most effective ACL reconstruction treatment, get in touch with Pristyn Care near you today.

Anterior cruciate ligament (ACL) tear commonly occurs in people who have an active ... Read More

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    Dr. Manu Bora (2CDYqEqpB0)

    Dr. Manu Bora

    MBBS, MS-Orthopedics
    17 Yrs.Exp.

    4.7/5

    17 + Years

    Delhi

    Orthopedic Surgeon

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    6366-370-250
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    Dr. Pradeep Choudhary (iInTxtXANu)

    Dr. Pradeep Choudhary

    MBBS, MS-Orthopedics
    33 Yrs.Exp.

    4.8/5

    33 + Years

    Indore

    Orthopedic Specialist

    Knee Replacement Speciaist

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    6366-370-250
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    Dr. Kamal Bachani (3uCOy0grwa)

    Dr. Kamal Bachani

    MBBS, MS(Ortho), M.Ch(Ortho)
    32 Yrs.Exp.

    4.7/5

    32 + Years

    Delhi

    Orthopedics

    Joint replacement

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    6366-370-250
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    Dr. Nallamothu Anil Kumar (FMnPN7WBhc)

    Dr. Nallamothu Anil Kuma...

    MBBS, DNB,MS-orthopedics
    29 Yrs.Exp.

    4.9/5

    29 + Years

    Hyderabad

    Orthopedic Specialist

    Knee Replacement Speciaist

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    6366-370-250
  • What is ACL Tear?

    An anterior cruciate ligament (ACL) injury is a tear or sprain on the anterior cruciate ligament in the knee. The anterior cruciate is a ligament located on the inside of the knee joint. It usually occurs in individuals who participate in athletic activities such as football, basketball, soccer, etc. In many cases, individuals hear a pop or feel a popping sensation in the knee when an ACL injury occurs. 

    The treatment procedure for ACL depends on the type and the severity of the injury. Severe ACL tear typically does not heal on its own, and prompt treatment is required to get rid of constant pain and discomfort. In minor cases of ACL tear, rest and rehabilitation exercises help you regain strength and stability.

    • Disease name

    ACL Tear

    • Surgery name

    ACL Reconstruction

    • Duration

    2 Hours

    • Treated by

    Orthopedic Surgeon

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    How is an ACL Injury Diagnosed?

    During diagnosis, a doctor conducts a physical exam to check the swelling and tenderness in the knee. A doctor also moves the knee into various positions to assess the range of motion and overall function of the joint. Moreover, a  doctor suggests a variety of imaging tests to rule out other causes and to determine the severity of the injury. These tests may include:

    • X-rays: X-rays are usually performed to rule out a bone fracture. However, X-rays don’t show soft tissues, such as ligaments and tendons.
    • Magnetic resonance imaging (MRI): This test involves radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage.
    • Ultrasound: In this test, sound waves are used to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons, and knee muscles.

    Are you going through any of these symptoms?

    What are the Different ACL Reconstruction Treatment Options?

    Different treatment options for ACL reconstruction surgery are as follows:

    Surgical treatment option:

    • Knee arthroscopy: Arthroscopic surgery is a minimally-invasive surgical procedure used to visualize, diagnose, and repair the anterior cruciate ligament using small instruments. During the surgery, a surgeon inserts a thin tube attached to a camera (a fibro-optic camera) into the joint via a small incision on the skin of the joint. Visualizing the joint via a camera helps the surgeon view the inside of the knee and to determine the severity of the condition. After that, a surgeon repairs torn tissues, shaves off damaged bone or cartilage and removes inflamed or damaged tissues. After that, a doctor closes the incision with stitches or small bandages and wraps the knee with a larger bandage or dressing. 
    • Knee ligament repair: Knee ligament repair is an outpatient procedure. In this procedure, a surgeon replaces the ligament with a piece of healthy tendon. This procedure is performed under the influence of anesthesia. The recovery period for knee ligament repair is quite short. 

    Non-surgical treatment options:

    Non-surgical treatment options include:

    • Apply ice to the knee a few times a day.
    • Prop the knee above the level of the heart.
    • Reduce or stop activity for a few weeks.
    • Compress the knee with a bandage or wrap.
    • Take anti-inflammatory drugs such as ibuprofen to lessen the swelling and speed up recovery.

    Benefits of Arthroscopic ACL Reconstruction Surgery

    Arthroscopic ACL reconstruction surgery provides various benefits, including:

    • Restoration of knee function:  ACL tears significantly inhibit the functionality of the knee. ACL repair surgery is the best option to restore knee stability and function effectively. The surgery addresses the root cause of the problem. It permanently repairs the torn ACL, restoring stability to the knee and allowing the patient to return to normal activities. 
    • Significant symptom relief: ACL tears can cause a variety of symptoms, including moderate to severe pain, lack of functionality, swelling, and weakness. Non-surgical treatment options are effective only in reducing the symptoms. The torn ACL is not healed through them.  Arthroscopic ACL reconstruction surgery can significantly reduce the pain, swelling, and limitations in the affected knee joint. 
    • Prevention of further damage: ACL repair surgery helps in preventing damage to the cartilage and surrounding knee structures. ACL repair surgery stabilizes the knee and prevents strain and possible injury to the rest of the knee structures. 
    • Cost-effective: The surgery also tends to be the most cost-effective than physical therapy, bracing, and other non-surgical treatments. 

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    Timeline For ACL Surgery Recovery

    The timeline for healing and recovery following anterior cruciate ligament (ACL) reconstruction surgery depends on multiple factors, which encompasses everything from prior fitness level to activity goals, surgical procedure, and post-operative guidelines. However, there are a few general guidelines common to many patients. Listed below is the timeline for recovery after ACL surgery:

    Weeks 1-3:

    The initial three weeks after surgery are the most crucial for healing time. Be diligent toward good nutritional intake, and the use of ice to control excessive inflammation is critical to promote the healing. During this period, the body is recovering from surgery and requires an optimal environment to ensure the readiness of the muscles to make necessary strength gains. It is extremely important to  regain control of the leg muscles, especially the quadriceps (thigh) muscle, to achieve normal gait and improve strength. Strength regaining is helpful for activities like stair climbing and standing from a seated position. Improving mobility of the knee is also important to improve function and serves a secondary purpose for healing. It also helps in distributing vital nutrients to the healing tissues.

    Weeks 4-6:

    During this period of recovery, remodeling of the tendon replacement, or graft, occurs. If an individual uses their own tendon as a replacement for the torn anterior cruciate ligament, then the tendon must undergo remodeling. During remodeling, the tendon breaks down (or remodels) into ligamentous tissue suitable to withstand the forces required of an ACL. By the end of this recovery period, patients note a significant improvement in recovery. If no other structures were repaired in addition to the ACL, many patients may be able to walk without an assistive device or brace, provided their quad recruitment has improved sufficiently. Due to decreased inflammation, they may also regain satisfactory mobility to perform activities like bending the knee to put on pants and other physical activities.

    Week 6-12:

    In this phase, the knee is capable of taking greater loads, and individuals may note the considerable gains in functional strength. Patients begin working on more activity-specific strengthening and weight-bearing exercises, such as squats, ascending and descending stairs, and balancing. You can also begin biking with resistance. The muscles begin to recover their normal function, and gait becomes quite normalized. Since the 6-12 week phase involves a lot of repetitive activities, diligence during this phase is critical as patients focus on building lower extremity strength, endurance, and control to enable progression to impact exercises in preparation for return to work, sport, or other activities during the next phase.

    3-6 months:

    By this time period, enough healing has occurred, and the ACL has gained sufficient strength to enable patients to return to running and jumping or impact activities. Greater recovery in muscle control and stability is also typically achieved. While the ligament can be subjected to greater forces, patients usually continue to exhibit poor coordinated lower extremity function. Therefore, ensuring the exercises are executed with good form and control is imperative to avoid increased stress on the reconstructed ACL and surrounding tissues.

    Training the leg to control jumping and landing properly is necessary to minimize the risk of re-injury when the patient returns to sports or recreational activities. Once sufficient lower extremity control is noted with jumping, hopping, and squatting, individuals can return to cutting activities. Ensuring good form with cutting is essential to full recovery as rotational motions such as pivoting and cutting mimic activities that are common to mechanisms of ACL injury. Often an individual will sustain an ACL tear due to poor leg stability or control during activities such as pivoting and landing from a jump, which is why a full recovery in function is essential to minimize the risk of future injury.

    6-12 months:

    During this period, the patient starts feeling better, and the doctor usually recommends resuming physical activities such as squatting, hopping, jumping, running, and cutting. However, the 6-month time frame is typically the earliest for patients to return to contact sports, as graft healing and recovery can take up to 12 months or more. Thus, to reduce the chance of re-injury, a person must be careful to maintain monitoring of lower extremity alignment and control while performing cutting, running, and landing.

    Risk and Complications of ACL Surgery

    Like any surgical procedure, ACL surgery also carries certain risks and complications, including

    • Anterior knee pain: The most common complication after ACL surgery is pain around the kneecap. It usually occurs in the patient who has surgery performed with a patellar tendon graft, as this procedure involves the removal of bone from the kneecap. 
    • Stiffness (arthrofibrosis): It is quite common to experience stiffness in the knee joint after an ACL injury. However, in most cases, it can be easily managed with aggressive rehabilitation. In some rare instances, a ball of scar tissue forms in the front of the knee, even despite rehabilitation. It can also lead to an inability to straighten the knee fully. 
    • Instability: In some cases, after reconstruction surgery, instability of the knee occurs. It is the result of a surgical error or an undiscovered injury that occurred in or around the knee at the time of ACL tear.
    • Graft stretching: When an ACL is reconstructed, the ACL is replaced by an autograft or allograft. In autograft, bone or tissue is transferred from one part of a patient’s body to another. An allograft is a transfer of bone or tissue from a donor or cadaver. In some cases, the graft used to replace a torn ACL is stretched, potentially leading to other complications like instability or graft failure.
    • Ganglion cyst formation: A rare complication from ACL reconstruction surgery is the formation of a cyst within or around the graft. These cysts are usually harmless and can be routinely removed, but they can sometimes cause symptoms like Knee pain, clicking of the knee, reduced knee extension, and stiffness. 
    • Growth plate injury: Bleeding at the incision site of an ACL surgery is common but can be a concern if the blood is excessive enough that it soaks through wound dressings and does not stop after pressure is applied to the area. 
    • Bleeding: Bleeding at the incision site of an ACL surgery is common but can be a concern if the blood is excessive enough that it soaks through wound dressings and does not stop after pressure is applied to the area. The reason for bleeding after ACL surgery varies and is usually caused by an underlying issue. For example, in some cases, injury to an artery during surgery may cause bleeding, and surgically repairing the artery will stop the bleeding from continuing.
    • Disease transmission: Infection is a rare complication but can be serious when it occurs. When the infection is inside the knee joint, there is a concern about the ACL graft becoming infected. If the infection is serious and does not get better with antibiotics, the graft may need to be surgically cleaned or removed to eliminate the infection.
    • Blood clots: Following ACL surgery, blood clots can form in the thigh or calf, with the potential to break off in the bloodstream and travel to other parts of the body, such as the lungs or brain.The reason for blood clots that develop after ACL surgery is unknown, but research suggests that factors can include a personal history of blood clotting, age (over 30 years), and hypertension.
    • Re-Rupture of the ACL Graft: Repeat rupture of the ACL graft is uncommon but sometimes occurs. Whenever there is a re-rupture of the graft, a surgeon should carefully assess for possible technical failures of the first surgery. Possible problems that can lead to the re-tear of the ACL include suboptimal positioning of the graft, improper tension on the graft, or failure of the fixation of the graft. 

    What Does Rehabilitation For ACL Injury For Athletes Entail?

    Generally, rehabilitation for ACL injuries lasts for around 4-5 weeks, but since athletes put more strain on their joints, they need longer rehabilitation periods for better movement. It also helps in preventing the recurrence of the injury. The treatment is usually performed with three goals:

    • Stabilizing the joint to promote healing
    • Strengthening the joint to increase the range of motion of the joint
    • Increasing joint flexibility to decrease the chances of re-injury following the return to sports

    Most athletes can start training for their sports about 4-6 months after the ACL surgery, but doctors usually recommend full rehabilitation before they start participating in the sports again. The rehabilitation period can be divided into the following:

    • Phase 1: 3-4 months after surgery- Regain strength and improve the flexibility of the joint.
    • Phase 2: 4-6 months after surgery- Low-level fitness and performance agility drills.
    • Phase 3: 5-8 months after surgery- Jumping exercises.
    • Phase 4: 6-9 months after surgery- Single-leg jumping exercises with sports-specific cutting.
    • Phase 5: 9-12 months post-surgery- Steadily increase sports drills till the former skill is achieved while focusing on preventing re-injury.

    ACL Surgery Cost in India

    The cost of ACL surgery in India ranges from Rs. 180000 to 242000. This is the average cost of surgery, the final cost of surgery can vary depending on various factors, including

    • Type of anesthesia administered
    • The city of the treatment
    • The general cost of hospitalization
    • General fees of the surgeon
    • Comorbidities such as diabetes, liver or lung disease, etc.
    • Type of graft used
    • Additional surgery 
    • Rehabilitation and physiotherapy 
    • Insurance coverage

    What are the Types of ACL Surgery Grafts?

    There are many variations of ACL reconstruction, each variation aims to give a patient the best functioning knee. The variability depends on what the graft, the new ligament, is made from.  In general, there are three main graft options, including

    • Patellar tendon autograft

    It involves harvesting the central one-third of the patellar tendon from the injured knee. The patellar tendon connects the patella, or kneecap, to the tibia or shinbone. When the graft is harvested, a small piece of bone is taken from the patella and the tibia, making it a bone-tendon-bone graft.

    The graft is inserted into the knee to form a new ACL using screws, and eventually, the graft bone fuses with the surrounding bone of the femur and tibia. The advantage of a patellar tendon graft is its strong initial fixation. The patellar tendon eventually regenerates in the donor’s knee. 

    • Hamstring Autograft

    It is a group of tendons that connect to the hamstring muscles of the back of the thigh. When a hamstring autograft is used, two of these tendons are removed and bundled together using sutures to create a tissue graft. The hamstrings are usually taken from the leg undergoing ACL reconstruction. The major advantage of this method includes a very small incision to harvest the tendon.

    The chances of risk of developing patellofemoral pain or patellar tendon rupture are quite low. Though the hamstring graft does not have as strong of fixation as the bone-to-bone fixation of the patellar tendon graft, the fixation is still very strong, and fixation methods are being improved upon all the time. Additionally, like the patellar tendon, hamstring tendons also regenerate.

    • Allograft

    It is taken from a cadaver donor and is also commonly used for ACL reconstruction. An allograft is not quite as strong as a patient’s own tissue. For a non-competitive athlete, an allograft can function at a very high level and allow a patient to return to their desired sports and activities. The main advantages of allografts include decreased operative time, less post-operative pain, and no need for harvesting incisions.

    There is always a minuscule risk of contracting a disease from the tissue because the tissue comes from someone else. However, advancements in screening and sterilization make this risk exceedingly small. Furthermore, because these grafts are thoroughly washed and contain very little protein antigen, the risk of graft rejection is also very small. Allografts are a good option for casual athletes, athletes over 40, revision or repeat ACL surgery, and those who absolutely prefer minimally invasive surgery.

    How to Find the Best Surgeon For ACL Surgery?

    If you are looking for the best knee replacement surgeon in India, then you must consider the following factors before choosing one-

    • Experience of the surgeon: It is one of the important factors that you should consider before choosing an orthopedic surgeon. Orthopedic surgeons deal with some serious health issues, so it is vital to consult an experienced surgeon with a good track of successful outcomes. 
    • Check the patient’s review and history: Check the patient’s review before finalizing the surgeon. It helps understand the surgeon’s professionalism, bedside manner, and communication skills. In short, it gives you a rough idea about the quality of care and the success rate.
    • Check the surgeon’s credentials and expertise: It is crucial to check the credentials of an orthopedic surgeon to ensure that the surgeon is up to date in his/her knowledge. It also clarifies that the surgeon has no major issues/complications in performing any treatment or surgery. Moreover, it also gives you an idea about the experience and expertise of the surgeon. 
    • Consider location and convenience: Consider a surgeon who is at a reasonable driving distance to avoid any complications during the treatment procedure. Apart from quality treatment, it is important that the orthopedic surgeon is easily accessible or available to maintain quality care, especially in emergency cases.
    • Research about the hospital: It is one of the important factors to consider before finalizing the surgeon. Investigate the hospital your orthopedic surgeon is associated with. It gives an idea about the medical staff, hygiene, and also the quality of care they provide. We suggest checking the patient testimonials and recovery outcomes before finalizing the surgeon.

    Is ACL Tear Surgery Covered Under Insurance?

    ACL tear surgery is usually covered under insurance because it is a medically necessary procedure that is typically performed to help individuals regain stability, function, and mobility in their knee joints. ACL injuries are common among athletes and active individuals and can occur due to sudden twisting or impact on the knee.

    The coverage may vary depending on the specific insurance plan and the individual’s medical history and needs. It is important to check with your insurance provider to understand what is covered under your policy and what out-of-pocket expenses you may have to bear.

    FAQs about ACL Surgery

    What are the most common choices of graft for ACL reconstruction surgery?

    The most common choices of graft for ACL reconstruction surgery include,

    • Patellar tendon autograft
    • Hamstring autograft
    • Allograft

    Is ACL tear surgery necessary?

    The necessity of ACL tear surgery depends on the type of injury. Partial tears can be managed using stretching and strengthening exercises. Therefore, for athletic people, surgery is recommended so they can resume their sports. Long-term instability of the knee can even promote arthritis, so it is crucial to keep up-to-date with strengthening exercises and wear a brace whenever you are moving your joint.

    Can I swim after ACL reconstruction?

    Swimming is usually recommended after ACL surgery as it strengthens the quadriceps (hamstring muscle), which helps support the tendon graft. However, swimming and running should be avoided for at least 4-5 months after the surgery. If you want to, you can swim with just your arms without paddling your feet 2-3 months after the surgery with your doctor’s approval.

    Will I have swelling after knee arthroscopy?

    Swelling after surgery is normal. It is a part of the healing process. In many cases, people experience moderate to severe swelling in the first few days or weeks after surgery and mild to moderate swelling for three to six months post-surgery.

    How to sleep after ACL surgery

    A doctor usually suggests sleeping with your knee raised but not bent. Put a pillow under your foot. Keep your legs raised as much as you can for the first few days.  

    What not to do after ACL surgery?

    After ACL surgery, you must avoid the following things to promote healing, including

    • Avoid swimming for 1-2 months,
    • Avoid using a heating pad
    • Avoid strenous physical activities

    When can I run after ACL surgery?

    A healthcare provider usually suggests that 3 months are enough to recover before running again. In some rare cases, 3 months is just not enough time for the structure of the ACL graft to have healed enough to withstand the forces of running. 

    Can ACL tears be treated without surgery?

    For minor ACL injuries, protective braces and physical therapy to strengthen the muscles around the knee is enough to cure ACL tears. In some cases, a doctor suggests applying ice to the knee for a few days to get relief from the symptoms.

    How soon can you walk after ACL surgery?

    A patient can usually walk 1-2 days after the surgery. Most patients can walk without a brace or crutches by 14 days after the surgery.

    What is the recovery time for ACL surgery?

    It usually takes six to nine months to recover completely after the surgery and return to participating in sports. Patients can walk with crutches and leg brace on the day of surgery. A doctor usually suggests a rehabilitation program just after the surgery to restore strength, stability, and range of motion to the knee.

    Is ACL surgery necessary?

    The treatment option for ACL injury depends on the severity of the injury. In severe cases, surgery is necessary to relieve the symptoms. In contrast, partial ACL tears can be treated effectively with non-surgical methods.

    Can I bend my knee after ACL surgery?

    You can bend the knee one day after the ACL surgery. But it’s vital to keep the knee joint completely straight immediately after the ACL surgery. It gives the joint time to heal properly without stressing the newly-fixed ligament.

    What happens in ACL surgery?

    In ACL surgery, a surgeon replaces the damaged ligament with new ACL graft tissue. The graft is either taken from the patient’s own body or donated by someone else.

    How soon can I start playing sports after ACL reconstruction surgery?

    After ACL surgery, it is usually suggested that an individual should wait up to nine months to heal completely after the surgery. However, in some cases, an individual can start playing sports within nine months.

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    Dr. Manu Bora
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    Last Updated : June 15, 2024

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    • RY

      Rajesh Yadav

      5/5

      Manu Bora's expertise and care truly made a difference in my recovery journey from an ACL tear. As an athlete, I was devastated after the injury, but Dr. Bora's surgical skill and personalized approach instilled confidence in me from the start. Throughout the process, he provided clear guidance and support, ensuring I understood every step of my rehabilitation. Thanks to his meticulous attention to detail and commitment to my well-being, I've not only regained full mobility but also returned to my sport stronger than ever. I cannot recommend Dr. Bora highly enough for his exceptional care and professionalism.

      City : DELHI
      Doctor : Dr. Manu Bora
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      Sanjay

      5/5

      Dr. Manu Bora became a lifeline for our family when my father needed ACL surgery. His expertise and warmth instantly put us at ease during a stressful time. Dr. Bora's thorough explanations and genuine concern for my father's well-being made all the difference. Throughout the recovery process, he remained accessible, answering our questions and offering encouragement. Today, seeing my father walk again with confidence, I'm immensely grateful to Dr. Bora for his exceptional care. He's not just a doctor; he's a guardian angel who restored hope and mobility to our family.

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      Aryan

      5/5

      I suffered from ACL tear after falling down stairs. But Dr. Manu Bora made it so much easier. Right from the start, he treated me like family, explaining everything in a way I could understand. His kindness and expertise gave me hope when I needed it most. Thanks to him, I'm on the mend and feeling better every day. Dr. Bora isn't just a doctor; he's like having a supportive friend by your side through it all.

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    • AR

      Arjun

      5/5

      I consukted with Manu Bora for my ACL surgery, and I'm so glad he did. I hurt myself playing sports, and he fixed me up real good. He explained everything in a way I could understand and made sure I knew what to do to get better. Thanks to him, I'm back on my feet and feeling great. If you need surgery like mine, Dr. Bora is the one to go to. He's awesome!

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      Priya

      5/5

      Watching my father go through ACL surgery was nerve-wracking, but Dr. Manu Bora's care was a beacon of hope during a challenging time. Dr. Bora's professionalism and compassion not only reassured my father but also comforted our entire family. He took the time to explain the procedure in detail, addressing all our concerns with patience and empathy. Today, seeing my father recover steadily, I'm deeply grateful to Dr. Bora for his expertise and support. He's not just a surgeon; he's a true healer who brings comfort and confidence to those in need."

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      Pooja Kapoor

      5/5

      Choosing Dr. Manu Bora for my ACL tear was the best decision I made, all thanks to a friend's recommendation. But what truly made the experience exceptional was not just Dr. Bora himself, but his entire staff. From the receptionists to the nurses, everyone went above and beyond to make me feel comfortable and cared for. Dr. Bora's expertise and warmth were matched by the professionalism and kindness of his team. Thanks to their collective effort, my recovery journey has been smoother than I ever imagined. If you're in need of orthopedic care, I couldn't recommend Dr. Bora and his wonderful staff highly enough.

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