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Should your daughter / son get their ACL tear fixed?

More and more kids are tearing their Anterior Cruciate Ligaments (ACL) - gone are the days of kids playing a sport and then having a few months of downtime to reat and recover. Nowadays kids seem to playing all year round and unfortunately there is a price to pay for that sometimes. So what are the options for a teenager that tears their ACL?


Managing ACL tears in pediatric patients (defined as anyone whose growth plates are still open) presents unique challenges. The orthopedic literature seems to delinate poor outcomes with nonsurgical treatment, including high risk of long-term knee problems. Patients often get recurrent instability, meniscus tears, and cartilage injuries. But there are risks associated with surgery in this patient population - growth plate injury which can cause leg length discrepancy (one leg shorter than the other), or angular deformity.


There are various ways to determine whether how much growth someone has left - chronological age, skeletal age (using xrays or MRI), and physiologic age using Tanner staging. There are 5 stages in the Tanner classification, with stage 1 essentially being prepubescent and 5 being postpubescent. I tend to rely on chronological age with Tanner staging as my decision making basis for whether to do ACL reconstruction on a pediatric patient or not.


Essentially if the growth plates are wide open, I tend to recommend a growth plate sparing ACL reconstruction using hamstring autograft. For those with little to no growth remaining, I perform a transphyseal (through the growth plate) ACL reconstruction, much like I would do in an adult.




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