Young athletes, especially soccer players, sometimes suffer anterior cruciate tears. Children who sustain ACL tears requires special type of surgical attention, because they are skeletally immature.Some teenagers and their parents are reluctant to choose surgery to reconstruct ACL tears, because they have heard there is a risk of damaging the growth plate in the proximal tibia (upper leg bone) or the distal femur (lower thigh bone).
However, according to a study published in November 2014 in the American Journal of Sports Medicine, pediatric ACL reconstruction can be done safely with the use of specialized techniques.
The researchers concluded that the surgery is “a safe option” for young patients. They wrote that the procedure produces “high functional and satisfaction results, without significant growth plate damage.”
The study was titled “Transphyseal Anterior Cruciate Ligament Reconstruction in Patients With Open Physes: 10-Year Follow-Up Study.” The authors were Calvo, Figueroa, Gili, Vaisman, Mococain, Espinosa, Leon and Arellano.
The researchers acknowledged that the procedure “is controversial, (though) current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage.” They suggested that most previous studies of ACL reconstruction in teenagers were too small or short term to produce reliable findings.
Calvo et al wrote that they sought “to determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients.”
The study involved 27 people who were between 12 and 16 years old when they underwent the surgical procedure. The researchers assessed them 10-13 years following their operations.
Among the factors examined to determine clinical outcomes were the patients’ preoperative conditions, details of their surgeries, follow-up medical reports and scores on knee-function tests. The analysis also took into account the patients’ ability to return to playing sports, and whether they sustained ACL reconstruction failures.
“The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs,” Calvo et al explained. “The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated.”
The researchers noted that there had been “significant differences” in the patients’ preoperative scores on several types of function tests. Two patients reported instability in their knees when they resumed playing sports. Three people experienced ruptures of the ACL graft.
Overall, the study confirmed that the surgery is safe for young patients. That is good news for those who have been unable to relieve their knee instability, and restore function, with physical therapy and other treatment. Athletes are particularly susceptible to ACL tears because of the strain their activities put on the ligament. In about half of the cases, there is also damage to other knee ligaments, the articular cartilage or the meniscus.
Injured ligaments, classified as “sprains,” are graded on a severity scale. A Grade 1 ACL sprain is the least severe, typically just an over-stretched ligament that does not impair normal knee function. A Grade 2 sprain involves a ligament stretched to the point that it is loose. This is sometimes called a “partial tear.” A complete tear, when the ligament is severed and the joint is unstable, is a Grade 3 sprain.
According to the American Academy of Orthopaedic Surgeons, ACL injuries are typically caused by abrupt movements like rapidly changing direction or suddenly stopping. They also result from slowing down while running, landing wrong after jumping and colliding with another person.
Women tear their ACLs at a greater rate than men. Sports like soccer, football and basketball are especially hard on knee ligaments. Among the symptoms are a popping sound in the knee, the joint giving out, pain and inflammation, diminished range of motion and pain while walking. If you have been diagnosed with an anterior cruciate tear, learn more about your options. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego.