Should My Child Have Surgery On A Torn ACL? – Boyd W. Haynes III, MD

Fall is here! The kids are back in school and are running around outside, playing games and sports. Many of them are participating in school sports programs, playing football, preparing for basketball and other intramural sports. Unfortunately, the increased rate of activity can also mean increased likelihood of injury.
A common sports injury is an ACL (Anterior Cruciate Ligament) Tear. The ACL is one of four ligaments that keep the knee stable during movement. The ACL can tear when there is a sudden, abrupt change in force to the knee. This can happen when children bend their knee sideways, stop or change direction suddenly, or twist their knees. It can also happen during sports that require a lot of jumping, pivoting and quick stops and starts, as is required in basketball, volleyball and soccer.
The initial treatment for an ACL injury is to use ice for the first 48 hours, rest, elevation, compression and pain medication. I will work with your child to determine if he or she would benefit from physical therapy, or if surgery would be the best option. Most young people who want to continue to play sports will choose to undergo ACL reconstruction surgery. For those who do not have surgery, there is the likelihood for repeated knee instability. Each time the knee gives out, there is a risk of increased damage to the meniscal or surface cartilage in the knee, which is extremely difficult to repair and can cause arthritis later in life.
Traditionally, many orthopaedic surgeons have been reluctant to perform ACL reconstruction on a young athlete. The concern was that, before a child has reached skeletal maturity (about 12-13 years old in girls or 14-15 years old in boys), this type of surgery presented a risk of injuring the growth plate in the leg. Growth plate problems resulting from ACL surgery could lead to unequal leg lengths or angular deformity. However, recent research shows that the risk of growth plate problems is much less than the risk of permanent knee damage, if the ACL is not fixed. The risk of meniscus tears and cartilage injury was found to be higher than the risk of growth plate disturbances. There have been modifications to traditional ACL surgery that allow the growth plate to be minimally-affected in children.
At OSC we perform surgery to reconstruct torn ACLs in young athletes whose knees either do not respond to physical therapy or are too wobbly to allow them to return to sports. Our surgical methods limit the risk of injury to growth plates on the bone. This increases the chances that your child will be able to return to sports, usually in four to six months after surgery. Our rehabilitation program includes regular physical therapy, designed so that your child will recover range of motion, rebuild strength and stability, restore balance and regain confidence in using the knee. I have many ACL tears in my adolescent population and recently had to perform ACL surgery on an 8 year old. He has done very well but before the surgery he had significant knee instability. He was back to full sports 6 months after surgery.
If your child experiences an ACL tear, I encourage you to seek immediate medical attention, followed by a visit with a sports medicine orthopaedist who can help determine the best course of treatment for your child.
Boyd W. Haynes III, MD is a fellowship-trained, board- certified Orthopaedic Specialist with Orthopaedic and Spine Center in Newport News, Virginia. Holding a fellowship in Sports Medicine, Dr. Haynes’ practice focus is Total Joint Replacement and Sports Medicine. For more information on Dr. Haynes or OSC, please call 757-596-1900 or go to www.osc-ortho.com.