|
ACL injuries and 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.
 |
|
|
|
|
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.
back to top
| back to The ACL
| First Aid
|
