It is frequently common that I see pediatric ACL patients. It is much more common now probably because younger patients are participating at higher levels of sports. We don’t like to see 11 and 12 year olds with acute ACL injuries, but it happens.
What is different about the pediatric ACL injury is the presence of skeletal immaturity. The growth plates are still active and open. This must be taken into consideration when considering treatment options.
ACL tears in younger athletes have been increasingly treated with surgery early. Many good studies indicated that the ultimate prognosis of the younger athlete’s knee depends on the intact meniscus. Meniscus tears happen about 50% of the time when an ACL injury occurs. That 50% risk continues for each time the pivots. Pivoting episodes are additional times that the shifts and swells. The goal in young athletes should be meniscus preservation.
The risk to the growth plate in ACL surgery is mostly theoretical. it doesn’t happen as much as we worry about it. However, certain surgical principles should be followed. No bone blocks across the growth plate with patellar tendon grafts. Avoidance of the growth plate with tunnels and fixation devices as much as possible. It is more important, however, to make sure the ACL graft is put in the right place. Conservative management of pediatric ACL tears is often surgical.
I take each case individually. You can have a 12 year old that looks 14 or one that looks 9. Keeping in mind that meniscus preservation is the primary goal, I may recommend activity modification until puberty. Early surgery is often needed before return to pivoting sports such as basketball, football, and soccer.