Pediatric ACL Injuries
What are some of the considerations for pediatric ACL reconstruction?
In pediatric patients with an ACL tear that are still undergoing growth, there is concern that continued activity without surgery can be associated with increased risk for damage to other structures within the knee including the cartilage and meniscus (See Picture) resulting in increased risk for earlier onset osteoarthritis. Conservative treatment without surgery can be recommended in kids with a partial tear, those who engage in low level activity, and do not have any other injuries within the knee. However, kids who have been found to have a complete ACL tear are indicated for surgical reconstruction. The growth plate in actively growing kids can be damaged during the drilling of tunnels for ACL reconstruction and therefore the surgical technique requires an adaptation. In kids with multiple years of potential growth, a standard adult ACL reconstruction can lead to limb length differences and possible deformity due to damage of the growth plate. Surgeons have created techniques to reconstruct the ACL without damaging or having only minimum contact with the growth plate. Patient age (usually >14 years old) as well as the beginning of menstrual cycles in females is the best indication of skeletal maturity and helps to determine how the procedure is performed.