5 Things You Probably Didn’t Know About Kids’ ACL Injuries

ACL injuries are common among young athletes, but also misunderstood. Here's everything a parent of a young athlete needs to know.

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This story was produced in partnership with Scottish Rite for Children.

For a kid who loves playing soccer, basketball, football, or any other fast-paced sport, suffering an ACL injury can be heartbreaking. Short for “anterior cruciate ligament,” the ACL is the strong band in the center of the knee that helps to stabilize it. But when the knee is forcefully hyperextended or twisted, the sudden movement or force may be too much for the ligament to bear, resulting in a tear. This is a fairly common injury in contact sports that, unfortunately, sidelines young athletes for the rest of their season, possibly even longer.

Take Anthony, a soccer player who tore his ACL when he was 12. He was originally advised to wait to have the reconstruction surgery until his growth plates had closed, likely a few years into the future. However, he went to Scottish Rite for Children where pediatric orthopedic surgeons were offering a new ACL reconstruction technique specifically for growing athletes. Scottish Rite’s sports medicine team recently published a study in the nation’s leading sports medicine journal, detailing a method that dramatically reduces the re-injury rate after surgery from 25 percent down to just 5 percent. In other words, the vast majority of kids who’ve undergone this procedure have resumed play and not needed to return to the operating table.

Anthony had the surgery, stuck to his physical therapy regimen and, nine months later, he was playing his first soccer game. He scored three goals in that game. Now 16, Anthony is still going strong with his soccer career.

No matter where a young injured athlete ends up, parents should do their homework on treatments and care centers and discuss their choices with orthopedic specialists. And even before any injury occurs, all parents of athletes should learn about this critical ligament, the risks that sports pose to it, and how an ACL tear can impact a child.

1. ACL Tears Are Most Common in Early to Mid-Teens

Although this injury can happen to kids as young as 5, Philip L. Wilson, M.D., assistant chief of staff at Scottish Rite for Children, says incidents tend to spike in the early adolescent years right after puberty. Why? For one, teen sports are typically faster-paced and more intense than those younger kids play, so they involve more pivoting, quick starts and stops, and big collisions, all of which can result in ACL injuries.

2. ACL Tears Need an Evaluation but Maybe Not in the ER

ACL injuries can be serious, for sure, but Wilson says they rarely warrant an emergency room visit. “If the joint has significant swelling, fills up with fluid, and the contours of the knee are distorted preventing you from seeing the normal shape of knee, then the injury needs to be evaluated by a sports medicine specialist,” he explains. “An urgent care or ER visit might be needed if the leg looks deformed beyond the changes in contours from swelling.” If there is no swelling, an ACL tear is less likely, but an evaluation is still appropriate.

3. Surgical Reconstruction Is Not Always Necessary for Tears

If the child has an ACL tear, it will require treatment, but that doesn’t always mean surgery. “We have good studies showing that with three to six months of physical therapy, some can function with an ACL injury without surgery,” Wilson says. “We call these athletes ‘copers.’ ”

Several other factors, such as joint stability, bone shape, and neuromuscular control, dictate whether or not a child would likely cope well with non-operative treatments. There must also be no accompanying damage to cartilage, namely the meniscus, which Wilson says is the case only 30 to 40 percent of the time. That doesn’t leave many kids as candidates to avoid surgical reconstruction.

4. The Re-Injury Rate for Typical ACL Surgery Is High — But Scottish Rite Is Changing That

According to Wilson, when high-level adult athletes have ACL reconstruction, the re-injury rate is quite low, just 4 to 5 percent. But among youth athletes, the re-injury rate has traditionally been a whopping five times higher: As many as 25 percent of kids will tear either the same ACL or the one in the other leg within five years of the operation.

There are two main reasons for this. For one, surgeons must use different surgical techniques to reconstruct kids’ ACLs than they use for adults. “Boys under the age of 16 and girls under the age of 14 still have active growth areas where soft cartilage will eventually become bone — this is how legs get longer,” Wilson says. The newly published technique offered at Scottish Rite for Children both allows for continued normal function of the growth plates when replacing the ACL and provides an added band for stability on the outside of the knee. This dual approach has shown to be very promising in an active, growing population.

Even after an ACL reconstruction, Wilson says teen athletes are prone to re-injury simply because they are active, participate in aggressive contact sports, and have less neuromuscular control than adults. Though rehabilitation and injury prevention training can help, getting the re-injury rate down to zero may never be possible in this population.

5. Effective Rehabilitation Takes Time

Not long ago, kids were cleared for sports as early as four months after an ACL reconstruction, but Wilson says we’ve learned that was way too soon. Even six months doesn’t allow for the necessary rehab, whether a child undergoes the traditional youth ACL reconstruction or Scottish Rite’s method. “It takes a very long period of physical therapy and performance training to get the leg and body back in shape,” he explains. “Many kids can be safely released to play fully at nine months, but research shows it can take up to 18 months to regain full strength and balance.”

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