Pediatric ACL reconstruction

Revolutionizing ACL Surgery for Prepubescent Athletes and Getting Kids Back to what they Love

The ever increasing competitiveness of kid’s sports has led to a rise in sports injuries in children. Traumatic injuries, previously common only among high school, college and professional athletes, are showing up with increasing regularity in children as young as their preteens due to long hours on the practice field and hyper-hectic game schedules.

Pediatric or prepubescent anterior cruciate ligament (ACL) injuries are serious and often meant an abrupt end to a young athlete’s budding sports career, as performing the type of surgery used to rectify similar injuries in an adult often would result in the disruption of bone growth and a short or crooked leg. Corrective ACL surgery could be performed when the child turned 16. Between the injury and a girl’s menarche or a boy’s starting to shave, kids with ACL injuries had to sit on the sidelines.

Ephyseal Sparing ACL Reconstruction

ACL injury need no longer be a major roadblock to young athlete’s progress thanks to the epiphyseal sparing ACL reconstruction that utilizes expendable tissue from the lateral aspect the thigh and avoids drilling through the growth plates. The procedure involves a zero risk of growth disturbance and a very low probability of requiring the typical adult surgery when the bones stop growing. A relatively short recovery period for the epiphyseal sparing means the young athlete can return to action six months post procedure.
Dr. Sanders has successfully performed over 250 epiphyseal sparing ACL reconstruction procedures. Studies have shown the procedure to be safe and effective with minimal risk of injury recurrence. http://www.ejbjs.org/cgi/content/abstract/87/11/2371.

As children become adolescents, the treatment for ACL injuries changes. Dr. James M. Tanner developed the Tanner Stages of Sexual Development. This has been shown to be a better index of a child’s remaining growth rather than the X-ray appearance of the bones.

To determine the Tanner Stage for an adolescent male, go to: http://www.fpnotebook.com/Endo/Exam/MlTnrStg.htm

To determine the Tanner Stage for an adolescent female, go to: http://www.aafp.org/afp/990700ap/209.html

Transphyseal Anterior Cruciate Ligament Reconstruction in  Skeletally Immature Pubescent Adolescents

It has been conclusively shown that children at the Tanner Stage 3, 4, and 5 can tolerate adult type procedures that drill across the growth plate without causing growth disturbance.  Typically, we select a graft from the quadriceps tendon because it is strong, and has not bone attached to it, which can, by cross healing lead to a growth disturbance.  Other than the graft choice, this procedure is identical to our adult procedure.

Summary

Despite the appearance of the bones on X-ray, the occurrence of menarche, facial hair, or the appearance of a Tanner Stage 5, these athletes are still children. ACL surgery is not for everyone. After surgery, exercises are started immediately. At the beginning, they are painful, and not fun. A young person must be sufficiently emotionally mature to power on through this period. If not, surgery is best deferred until a sufficient amount of emotional maturity has developed.

After reconstruction of the anterior cruciate ligament, these young athletes are no longer at excessive risk for further episodes of knee subluxation (giving way) and subsequent injury to the menisci. At 90 days post-surgery, nearly all of those patients with the adult procedure (Tanner stage 3 and 4) are able to return to their favored sport without a knee brace. Those with epiphyseal sparing procedures may return to sports at 180 days. For these children, a knee brace is an option. We know that these are the most athletically active years in a young person’s life and believe it is no longer necessary to cause these young people to give up the activities which they covet most.

Lastly, we must keep in mind that these youngsters are exactly the ones that continue to put their knees at risk when they return. Typically 10 to 15 percent of them will re-tear their reconstruction or tear their opposite ACL as a result of another equally serious accident. In order to prevent such recurrence, we have initiated a program to improve balance and neuromuscular coordination. After a successful neuromuscular program, tears of the opposite ACL, and/or ACL graft are uncommon.

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