Grade 3 dislocation of ACL. Is surgery compulsory?

Q. Is surgery necessary for grade 3 dislocation of ACL?

Answered by
Dr. Anuj Gupta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 03, 2023

Hello doctor,

My husband dislocated his ACL. I would like to get his X-rays evaluated for a second opinion. He was diagnosed with grade III dislocation. Is surgery necessary based on the X-rays attached? What are the risks if he does not operate? How does non-operative treatment compare? How long does he have to make a decision on surgery based on the X-rays? The doctors mentioned that if he does surgery, he would need to have two procedures. Could you advise what are the names of the procedures to repair his shoulder? It was also noted that there is haziness in the lower lung. Is immediate treatment needed for this? How severe is this?



Welcome to

This is clearly acromioclavicular joint injury (attachment removed to protect patient identity). There are two ligaments which basically keep our ACL joint in position. In type 3 injuries, both ligaments are torn. Now, according to literature, treatment of type 1,2 injuries is non-operative and type 4,5,6 is operative. But the treatment of type 3 is controversial. It is basically surgeons choice. I usually try for six weeks conservative and if my conservative treatment fails then I go for operative. Operative treatment depends on the time of injury. If it is acute, then we can apply a hook plate. In old injuries, we can do mini-open endobutton fixation. I am sorry, I cannot guide you for the type of surgery because you have not mentioned the day of injury. Nothing is to be done for chest if it is not symptomatic. I think it is just an incidental finding.

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