ACL TEARS IN CHILDREN

Several studies and articles have been published recently describing the increased occurrence of ACL tears in children and young adults. Most orthopedic surgeons and researchers attribute this phenomenon to more children and young teens playing competitive sports, as well as better diagnostic tools. The ACL is a stabilizing ligament that connects the femur, or thighbone, to the tibia, or shinbone. The ACL is what gives the knee the stability to play sports that require quick pivoting, such as football, volleyball, and basketball, among others. In children as in adults, sometimes this ligament can tear when it is placed in high-stress situations. Unfortunately, the ACL is unique in that it will not repair itself with rest and stabilization; the only way to restore function to a torn ACL is to surgically reconstruct it from another piece of tissue.

ACL tears in children present a variety of challenges to patients, parents, and surgeons. The ultimate treatment goal is to give the child a functioning ACL without causing damage to the growth plates in the femur and tibia. Historically, the question of what to do for a torn ACL in a child has been controversial. Years ago, the standard of care was to operate only after the bones had stopped growing, at about age 14 for girls and 16 for boys. During the interim between injury and surgery, children were told to avoid sports that involved repeated pivoting motions, complete physical therapy, and wear a knee brace for stabilization. However, these children who waited years to have their ACLs reconstructed often faced further damage to their already injured knee, such as degradation to the cartilage on the ends of the femur and tibia, and damage to the cushioning meniscus. Unfortunately, these children also missed out on playing the sports they loved. From a parent’s point of view, it has also proved to be extremely difficult to limit the activities of children in this age group, and make them wear a knee brace consistently.

Today, surgical techniques have evolved to allow surgeons to reconstruct the ACL while minimizing the risk of damage to the bone growth plates. Although immediate surgical repair may seem like the more radical option, it is considered by most orthopedic experts to be the best option for giving a child a functioning knee in the years to come, avoiding further damage, and allowing him or her to continue playing sports.

If your child has suffered an ACL tear, make a consultation with Dr. Millstein to discuss your options. Dr. Millstein has extensive experience reconstructing ACLs and will develop a plan of care that uses the most advanced surgical techniques available and aims to give your child a fully functioning knee for years to come.