Should my child have anterior cruciate ligament (ACL) reconstruction before he/she is finished growing?

The decision to surgically reconstruct the anterior cruciate ligament (ACL) in children is not a black-and-white one. Both non-operative and surgical treatment have their own benefits and risks, and a surgeon experienced in sports medicine should be consulted to determine the right course of treatment. While each decision is made on a case-by-case basis, there are some specific risks and benefits to be aware of.

Non-operative treatment for pediatric ACL injuries includes physical therapy and changes to the child’s activity level. Changes to a child’s lifestyle, however, can often be difficult to implement and can limit the type of sports and activities that they can take part in. In addition, if left untreated, recurrent knee instability and giving-way episodes due to ACL injury can lead to irreversible meniscus and cartilage damage in the knee, which can be painful in the short term and lead to arthritis in the long-term. For very young children with an ACL injury, the best course of action may be to try non-operative care initially and leave open the possibility of surgical treatment if they have subsequent instability.

ACL reconstructive surgery is a well-established and successful procedure, but like non-operative treatment, it holds special risks in the setting of a growing child. Risks of ACL reconstruction in the pediatric patient include damage to the growth plates about the knee. Injury to the growth plates can lead to additional surgery to avoid deformity of the operated knee. There are well-established surgical techniques to avoid damaging the growth plates during pediatric ACL surgery, however, that have shown good long-term results.

If a child has recurrent knee instability and he or she is nearly finished growing, ACL reconstruction is a safe and extremely successful procedure. For younger patients who have much growth remaining, in some cases it may be better to wait and see how the child responds to non-operative care before proceeding to surgery. However, it is very important that the patient not have recurrent instability because injury to the meniscus can have a profound effect on the development of arthritis in the knee. Ultimately, the decision of non-operative or operative treatment for ACL injuries in growing children should be made by a physician and the child’s parents on a case-by-case basis.

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