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New Advancements in ACL Reconstruction May Be Just in Time for Athletic Youths

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New Advancements in ACL Reconstruction May Be Just in Time for Athletic Youths

March 13, 2012

Written for Knee1 by Craig Gaffney

ACL (Anterior Cruciate Ligament) tears are most often associated with athletes in their twenties and thirties. Because of this, not a lot of attention has been directed towards ACL injuries in athletic children. While once considered rare, recent studies and anecdotal evidence from doctors indicate a sharp upward trend in these knee injuries among kids and adolescents.

One reason for this increase may be pressure to succeed in sports. “We’re seeing these injuries more frequently than we did before, and I think it’s because the kids are just playing at a much higher, competitive level at younger and younger ages,” says Dr. Mininder Kocher, pediatric orthopedist at Boston’s Children Hospital.

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Causes of ACL Injury
  • Sudden change in direction after quick deceleration
  • Uneven muscle conditioning
  • Wide pelvis structure resulting in angled femur
  • This desire to emulate their favorite athletes may lead to children restricting themselves to one sport year-round. Many children feel pressure from themselves and their parents to excel at one sport, but this prevents a balanced approach to training and fitness. Without an appropriate range of activities, they cannot target all muscle groups in their legs. The hamstring-quadriceps strength ratio is typically affected by this type of one-way conditioning, and without a good balance between the two muscles the chances of injuring the ACL increase.

    Once a child injures his or her ACL, it is not an easy road to recovery.

    “Because of their age and because of their growth, that injury and the implications of it are tremendous from all angles,” says Dr. Todd Lawrence, assistant professor of orthopedics at Children's Hospital of Philadelphia. An injury to the ACL can lead to long term instability, risk of future injury, and increased risk of arthritis in the joint.

    Proper surgical care can prevent these risks, but can also potentially pose some of its own. The decision to operate presents a unique challenge for parents and doctors. Fear of damaging growth plates often prevents surgeons from reconstructing the ACL immediately. If part of the growth plate is damaged, a child’s legs could grow unevenly.  

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    What you can do:
  • Make sure to exercise your quads and hamstrings equally
  • Avoid wearing shoes with too much traction, if possible
  • Determine if your bone structure puts you at higher risk for ACL injury (hip width, pelvis width are good indicators)
  • However, research indicates that children who wait more than 150 days before having surgery put themselves at higher risk for other knee injuries, possibly due to further aggravation through activity or by compensating when walking. These additional injuries “increase recovery time, inhibit return to play, and worsen long term functional outcomes of the knee,” according to Dr. Guillaume D. Dumont of the University of Texas Southwestern Medical Center.   

    Luckily, your child’s ACL surgery may not be a “damned if you do, damned if you don’t” decision. Recent simulations conducted by Dr. James Kercher and presented to the American Academy of Orthopedic Surgeons show that with appropriate digital mapping of the child’s knee and the right-sized graft tunnel, a surgeon can successfully reconstruct the ACL without significantly damaging the growth plate.

    “We found that we were not removing as much of the growth plate as we thought,” says Dr. Kercher. “The simulated reconstructions removed between 2 percent and 3 percent of [its] volume… [This] module may be helpful in preoperative planning.”

    If Kercher’s trials can be translated to real surgical results, ACL Reconstructive surgery in children may no longer hold such a negative stigma. By developing a plan with the surgeon, the child may be given his or her best chance to avoid complications from the injury and get back to just being a kid.

    Discuss in the Knee1 Forums

    Photo: Todd Butkowski 

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