News | Published February 25, 2013

Pediatric ACL injuries – how treatment can prevent long-term issues

As the number of children participating in sports continues to grow, we are seeing more significant injuries of the knee, including anterior cruciate ligament (ACL) tears.

According to an article in the February issue of Journal of the American Academy of Orthopaedic Surgeons, ACL injuries were once considered rare in children and adolescents. Now these injuries are on the rise “whether they result from year-round training, less free play or increased single sport concentration,” said lead study author and pediatric orthopedic surgeon Jeremy Frank, MD, with Joe DiMaggio Children’s Hospital’s Department of Pediatric Orthopaedics and {U18} Sports Medicine in Hollywood, FL.

The article states, “Until a child’s bones have fully matured (in girls, typically by age 14; in boys, age 16), an injury to the ACL – the primary, stabilizing ligament of the knee joint – requires special consideration, treatment and care to ensure appropriate healing and to prevent long-term complications.”

These complications, according to the article’s authors, could include osteoarthritis and cartilage disease.

Some recommendations for avoiding potential complications shared in the article:

  • Children should be treated by an orthopedic surgeon who has expertise in the operative treatment of pediatric ACL injuries.
  • For pediatric and adolescent patients with partial ACL tears comprising less than 50 percent of the diameter of the ligament, non-surgical management, including activity modification, bracing and/or physical therapy, can be considered.
  • Treatment for complete ACL ruptures typically involves transphyseal ACL reconstruction surgery that partially or completely spares the femoral physis (the growth plate, contributing to 70 percent of thigh-bone growth), and adult-type surgical or arthroscopic reconstructive in adolescents at or nearing skeletal maturity.
  • Postoperative management may include weight-bearing and activity modifications, bracing and a progressive physical therapy program emphasizing range of motion, closed-chain strengthening (exercises on the knee while the foot remains stationary) and a gradual and measured return to sport-specific maneuvers and activities.