Dr. Marx recently published a paper in the American Journal of Sports Medicine that the incidence of anterior cruciate ligament (ACL) injuries in children and adolescents is on the rise. These injuries are increasing in frequency for several reasons: kids are playing more sports, they are playing more frequently, more competitively and the diagnosis is made more easily thanks in part to MRI.
Why do ACL injuries in kids often need surgery?
The problem with ACL injuries in kids is that the knee is often unstable with cutting and pivoting sports. Even young people who are not very active in athletics will generally run, dance, jump and do activities that could lead to instability if they have an ACL deficient knee. ACL related knee instability is not only unpleasant because of pain and subsequent swelling, but it can also lead to further knee injuries such as meniscus and articular cartilage damage. This can in turn lead to arthritis at an early age, which can severely limit quality of life. For these reasons, the preferred treatment for an ACL tear in a child or adolescent is generally surgery, to reconstruct the ACL.
Pediatric ACL reconstruction in kids
ACL reconstruction is done differently in children who are still growing, as opposed to adults or adolescents who have completed their growth. Standard ACL reconstruction is performed by placing tunnels in the bones around the knee and then inserting the new ligament through the tunnels. If the child is still growing, the tunnels with cross the growth plates and can interfere with the child’s normal growth leading to abnormal alignment. Therefore, when performing pediatric ACL reconstruction, the surgeon must avoid damage to the growth plates by using smaller tunnels, not placing fixation across the growth plates, using soft tissue grafts or, in very young children, avoiding tunnels altogether. Deciding when and what sports kids should go back to can be challenging.
ACL Prevention: The Best Treatment!
Over the past decade, it has been shown that many ACL tears can be prevented through an exercise program that focuses on strength, body position and proprioception (which is the body’s ability to balance and to know where the limbs are in space). These programs have demonstrated a reduction of 50-75% in ACL injuries. Prevention programs are the topic of Dr. Marx’s book The ACL Solution: Prevention and Recovery for Sports Most Devastating Knee Injuries. Prevention is not only for kids who have not been injured, but also those returning to sports, to prevent knee re-injury and also injury to the other knee which is at equal risk of ACL tear in the future.