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ACL injuries and children

ACL injuries in children ACL injuries do occur in children. If your child tears his or her ACL while playing sports or in an accident, you will have a lot of questions about what this means to your child now, and in the future. The bones and joints of children are very different from the bones and joints of adults because children's bones are still growing. This can make caring for children with an ACL injury a bit more complicated. Your orthopedic surgeon will want to find the best way to make sure that your child has a good knee that functions normally and does not hurt. The main worry that orthopedic surgeons have when taking care of children with knee injuries is how to accomplish these goals without either excessive restrictions on the type of activities the children can do or changing the way children's bones would grow normally. This can be difficult because children are very active and it is hard to get them to slow down and avoid certain activities that may damage their knees. At the same time, ACL surgery for children is more difficult than it is in adults because there is the risk that the normal development of the bones can be changed by the surgery.

ACL surgery is not an emergency. This means that you can safely wait for as long as you need in order to decide how your child's injury should be treated. Nearly all ACL injuries in children are first treated with a course of supervised physical therapy and rehabilitation. This involves strengthening the hamstrings and quadriceps muscle, helping the swelling to go down, and regaining the motion in the knee. You can read the section about rehabilitation for more information about what happens in this process. This initial phase of treatment will give you the chance to learn more about the options for ACL surgery in children.

Being faced with the decision of whether or not to have surgery performed on your child is a very difficult situation to be in. Many parents have a lot of questions and anxiety about what will happen to their child's knee if they do not have surgery. Unfortunately, there is very little scientific data that can tell us for certain what the long-term consequences of ACL injuries in children are. Nearly all children want to play sports and be as active as they can be. There are some situations in which ACL injuries in children can cause enough looseness in the knee that participation in certain sports carries a very high risk of damaging the rest of the knee if the ACL is not fixed. These sports involve running, jumping, and changing direction quickly, like soccer, basketball, baseball, or skiing. In this situation, your child should either stop participating in these sports, or have his/her ACL fixed. However, if your child does not play these sports, or if your doctor believes that your child's knee does not have a significant amount of looseness after the ACL has been torn, then your child may not have to have surgery.

Bones grow from the growth plate (called the physis by doctors), which is located very near the knee joint in the ends of the femur (thighbone) and the tibia (shinbone). Modern techniques for reconstructing the ACL involve drilling tunnels in the bone through the area of the growth plate. This does not cause any problems in adults because the growth plate closes at the time of skeletal maturity. If a part of the growth plate is damaged, and does not grow normally, the rest of the bone can grow in an abnormal fashion. Doctors call an injury to the growth plate a "partial physeal arrest." When this happens, the rest of the growth plate produces bone asymmetrically. As a result, either the tibia or the femur can grow at an incorrect angle, producing a skeletal deformity. In general, the closer your child is to reaching skeletal maturity, the less risk they have of their tibia or femur growing at an abnormal angle if their growth plate is injured. Very young children, who still have a lot of growing to do, have a greater risk of permanent damage if their growth plate is injured. Every child is different, and so far, doctors have not been able to say for certain when drilling a small hole through the bone that goes through the growth plate is safe. This has led to the development of number of different surgical techniques that try to minimize the potential for damage to the growth plate. Currently, there are no solid recommendations for which surgical techniques are best for which age groups. Children who are close to maturity and generally more than about fourteen years old can have their ACLs replaced safely with standard techniques. Children who are much younger may need to either wait until they are older, or if their knee is unstable enough they may need to have a different type of reconstruction that avoids drilling holes through the growth plate.

Growth plates (Image credit: Seif Medical Graphics)

 

Screws penetrate the growth plates (Image credit: Seif Medical Graphics)
Screw avoids the growth plates (Image credit: Seif Medical Graphics)
different techniques for graft fixation can avoid drilling holes through the growth plates
bone tunnels have been drilled through the growth plates
 

 

Each decision about ACL surgery in children is unique. You will need to have a discussion with your doctor about what your options are and how to make a decision that you and your child will be comfortable with.

 

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