The anterior cruciate ligament (ACL) is one of the main stabilizing ligaments of the knee joint. Though ACL tears have been reported in children as young as two years, they are more likely to occur in teenage girls when compared to boys involved in similar sporting activities.
According to Seattle Children’s Hospital, ACL injuries are harder to treat in children due to the presence of epiphyses or growth plates in their leg bones (tibia) and thigh bones (femur). As a result, non-surgical measures are usually used to treat these injuries in order to avoid the leg length inequality and angulatory deformities that may arise if the growth plate is injured.
These non-operative measures usually involve bracing and strengthening exercises. The children are also advised to avoid sporting activities like basketball, volleyball and soccer which involve changing directions suddenly and knee twisting motions.
If these conservative measures fail, surgical options can be considered. According to the American Academy of Orthopedic Surgeons, the orthopedic surgeon can modify the traditional ACL surgery technique to reduce the risk of growth plate injury.
These modifications can include placing the tendon graft in a non-anatomic position or wrapping the graft around the bone to avoid drilling holes through the growth plates. These non-standard measures are designed to temporarily control the symptoms until the patient reaches skeletal maturity when a traditional reconstruction can be done.
After the modified ACL reconstruction surgery, Cincinnati Children’s Hospital states that children should be admitted into a rehabilitation program that includes regular physical therapy to help them recover their range of motion, rebuild strength, restore balance and regain confidence in using their knee.
Parents of children with anterior cruciate ligament tears should therefore ask their orthopedic surgeon if the mode of treatment they choose will effect their child’s growth plates and lead to growth abnormalities.
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