ACL Tears in Kids: When to treat surgically

ACL tears are one of the most common injuries seen in my office.  The treatment of these injuries has been a topic of much debate in the orthopedic world.   Surgical refinements and follow up studies have helped guide the way.  Over the past few years, I have performed a number of ACL reconstruction surgeries on young people, with ages typically ranging from 11 to 14.  This has been a topic of much debate in the orthopedic world, and there is no one perfect recommendation for everyone.  Part of performing the reconstruction involves creating bone tunnels.  These tunnels tend to pass through the growth plates, or section of the bone that grow to lengthen the bone and make you taller / longer.   In adults, these growth plates are shut down, and making the tunnels does not cause a problem.  In kids, the concern has always been the possibility of creating a ‘growth arrest’ or having the bone stop growing, leading to differences in leg length, or abnormal growth.

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Arthroscopic view of a reconstructed ACL graft

Graft choice is often a big part of the surgical discussion.  You can read more about ACL graft choices.  The use of a soft tissue ligament graft has been met with great success.   Studies to date do not suggest that one graft is better than the other (hamstring / BTB).  There is some data showing that auograft does a little better than allograft.  While graft choice is important, it is just one of many important decisions to be made surgically that affects outcome, not the only one.  Tunnel placement, for example, may be more important.