ACL Injuries in Children and Teens

by / Monday, 27 May 2019 / Published in Blog

Children and adults have slightly different anatomy and physiology. The main difference between the knee in an adult and a child is the growth center or physis. Growth centers are regions at the end of the femur and tibia, on both sides of the knee. These growth centers provide most of the growth of the leg but they are usually the weakest parts of the knee. An injury that could tear a ligament or cartilage in an adult’s knee is more likely to fracture the bones in a child’s knee.

However, adult-type knee injuries can still occur in the child. ACL or Anterior cruciate ligament tears are being increasingly reported in children. These injuries are mostly non-contact and occur during activity that involves abrupt halting or change of direction forces. A ‘pop’ may be heard at the time of injury. The knee generally swells within 6 hours of the injury.

Treatment of ACL Injuries in Kids

The treatment of ACL tears in the adult knee is usually reconstruction. A healthy tendon is taken from another part of the body and used to repair the torn ligament. Conservative treatments with braces and exercise do not usually work in extensive ligament tears. These patients report the knee “giving way” as well as tearing of other soft tissues, such as the meniscal cartilage. All these may lead to early onset of arthritis.

If the patient is within a year or two of skeletal maturity, most physicians perform a standard ACL reconstruction. However, for younger patients, alternative techniques are employed to reduce the likelihood of growth arrest. These techniques involve placing the graft such that it does not completely duplicate normal ligament function. Holes are drilled in a way that they go around instead of going through the growth centers, or holes may be avoided altogether, and the graft is wrapped around the bone. These procedures yield good results and over 95% of children are able to return to sports without needing a later procedure.