A pediatric anterior cruciate ligament (ACL) tear is an injury to one of the four major ligaments of the knee. The ACL is a ropelike structure in the center of the knee that helps maintain the normal relationship between the femur (thigh bone) and tibia (leg bone).
When torn, the ACL does not heal, and the knee can become unstable or give way during activities that require pivoting, changing direction, jumping, or landing. ACL tears in pediatric patients pose an additional challenge because typical ACL reconstruction procedures can injure the open growth plates around the knee and affect normal growth.
What Is a Pediatric ACL Injury?
The ACL is one of the four major ligaments of the knee. It is a ropelike structure in the center of the knee that helps maintain the normal relationship between the femur (thigh bone) and tibia (leg bone).
When the ACL is torn, it does not heal on its own. The knee may become unstable, shifting or giving way during sports and activities that require pivoting, cutting, jumping, or landing.
About half of people who tear their ACL also tear a meniscus in the knee. In pediatric patients, treatment also must take into consideration the open growth plates around the knee because typical ACL reconstruction surgery can injure these growth plates and affect normal growth.
Causes and Risk Factors
ACL tears may occur from:
- Non-contact injuries, such as landing awkwardly or cutting
- Contact injuries in which the knee sustains a direct hit, such as being tackled at the knee
Risk factors include:
- Sports that require pivoting, jumping, cutting, or changing direction, such as basketball, soccer, and volleyball
- Contact sports such as football and rugby
- Poor physical conditioning
- Female gender
- High friction or traction between the playing surface and shoe
Symptoms
Signs and symptoms may include:
- A pop or tear heard or felt at the time of injury
- Inability to continue playing after the injury
- A large amount of knee swelling within six to eight hours after the injury
- Inability to straighten the knee after an injury
- Knee instability, particularly when trying to pivot, cut, or jump
- Swelling with repeated episodes of giving way
- Occasional locking when there is an associated meniscus injury
Treatment
Initial treatment focuses on returning the knee toward its pre-injury condition by reducing pain and swelling and restoring range of motion, strength, and normal walking.
Walking with crutches until the patient can walk without a limp is often recommended. Range-of-motion, stretching, and strengthening exercises may be performed at home, although referral to a physical therapist or athletic trainer is often recommended. If other ligaments are injured along with the ACL, Dr. Chudik may recommend a brace to help keep the knee stable.
For young active patients, surgery to reconstruct the ACL usually is recommended to allow a return to activities and sports. Surgery also is appropriate for young active children who have ACL injuries combined with injuries to other ligaments, the meniscus, or the articular cartilage.
Dr. Chudik developed a special technique to reconstruct the ACL in young patients while avoiding injury to their open growth plates.
Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers such as acetaminophen, are sometimes recommended as directed by a physician.
Cold can be used to relieve pain and reduce inflammation. It may be applied for 15 to 20 minutes every two to three hours for inflammation and pain and immediately after activities that aggravate symptoms. A cloth should be placed between the ice and skin.
Recovery and Outcomes
The ACL will not heal on its own, but most people can perform normal daily activities after an appropriate rehabilitation program.
For young patients and those who want to return to sports, surgery is recommended. If the ACL is left untreated, knee instability can place the patient at risk for further injury to the meniscus and cartilage and the development of early arthritis.
ACL reconstruction that avoids injury to the growth plate can result in a stable knee, help prevent early progressive damage to the meniscus and cartilage, and allow a return to full activities.
Potential complications associated with an ACL injury may include recurrent instability, further meniscus injury, injury to the articular cartilage or other knee ligaments, knee stiffness, and arthritis. Surgery also carries a risk of injury to the growth plate and growth abnormalities.
When to See Dr. Chudik
Contact Dr. Chudik’s office for evaluation of a pediatric ACL injury, particularly if the knee continues to shift or give way, remains swollen, or has associated symptoms that interfere with activity.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.