Pediatric ACL injuries are ACL tears in skeletally immature athletes, patients whose growth plates are still open. They require different surgical consideration from adult ACL tears because traditional reconstruction techniques can damage the growth plates and cause limb-length discrepancy or angular deformity. Dr. Chudik developed an arthroscopic growth-plate-sparing ACL reconstruction technique that allows pediatric athletes to be treated safely at the time of injury rather than waiting years for skeletal maturity.
What Is a Pediatric ACL Injury?
A pediatric ACL injury is functionally the same ligament injury as an adult ACL tear: the ACL ruptures, the knee loses rotational stability, and the child develops instability with pivoting, cutting, jumping, and landing. What differs is the surgical anatomy and the risk profile.
In skeletally immature patients, the growth plates (physes) of the distal femur and proximal tibia are still open and actively producing bone. Traditional ACL reconstruction techniques drill bone tunnels through the physes to anchor the graft. Tunnels across open growth plates can damage the physis and lead to:
- Early partial or complete closure of the growth plate
- Limb-length discrepancy
- Angular deformity (valgus or varus)
For decades, these risks led surgeons to recommend bracing and activity modification until skeletal maturity, then performing reconstruction in the adult manner. This approach produced a generation of young athletes who developed meniscus and cartilage damage during years of instability, arriving at reconstruction with secondary injuries.
Causes and Risk Factors
- Non-contact pivoting injuries during sport
- Direct blow to the knee
- Landing from a jump with poor mechanics
- Female sex, particularly after puberty, when relative ACL injury rates rise
- Participation in high-risk sports (soccer, basketball, football, skiing, lacrosse, gymnastics)
- Early sport specialization and year-round play
Symptoms
- Pop during the injury event
- Immediate swelling from bleeding into the joint
- Inability to continue activity at the time of injury
- Subsequent instability with cutting, pivoting, or stair descent
- Associated meniscus tears are common and produce catching or locking
Diagnosis
Dr. Chudik’s evaluation is similar to the adult ACL examination, adapted for skeletal maturity. Physical examination includes the Lachman and pivot shift tests. Assessment of skeletal age is important: Tanner stage, bone age X-rays, and growth plate imaging help determine the remaining growth potential and inform the choice of surgical technique. MRI confirms the ACL tear and characterizes associated injuries. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is reserved for partial tears and for patients unwilling to pursue surgical treatment. It involves a targeted physical therapy program, activity modification, and bracing for pivoting activities. For pediatric athletes who want to return to sport, non-surgical treatment is rarely successful because the knee remains unstable for all high-risk activities.
Surgical reconstruction is recommended for complete ACL tears in skeletally immature patients who want to return to pivoting sport. Dr. Chudik developed an Arthroscopic Pediatric Growth-Plate-Sparing ACL Reconstruction technique that reconstructs the ACL without drilling tunnels across the open growth plates. The technique allows these young athletes to be treated at the time of injury, preserving their knee and minimizing the risk of progressive meniscus and cartilage damage that occurs during prolonged instability.
Recovery and Outcomes
Recovery after pediatric growth-plate-sparing ACL reconstruction is similar in cadence to adult ACL recovery: early motion, progressive weight-bearing, dedicated rehabilitation, and return to sport after objective testing at six to nine months. Because young athletes often heal faster biologically, the rehabilitation focus is on preventing re-tear through neuromuscular training rather than on accelerating the timeline.
Outcomes after pediatric growth-plate-sparing reconstruction are very good, with return to sport rates comparable to adult ACL reconstruction and low rates of growth disturbance when the technique is performed correctly.
When to See Dr. Chudik
Schedule an evaluation for any child or adolescent with a knee injury that included a pop, immediate swelling, or subsequent instability with sport. Call 630-324-0402 or request an appointment online.