Treating ACL tears in youth athletes


Youth athletes are experiencing tears of a knee ligament at alarming rates. These injuries, known as anterior cruciate ligament (ACL) injuries, occur with sports that involve pivoting and side-to-side motions, like soccer and skiing. Because the young athletes are often still growing, orthopaedic specialists must take special care. Treatment should control long-term damage and prevent debilitating conditions like arthritis while also protecting future growth.

Related post: ACL tears in young athletes at epidemic levels

Treating ACL injuries

If an orthopaedic specialist diagnoses your child with an ACL tear, both nonsurgical and surgical treatment options may be available:

Nonsurgical treatment

A nonoperative approach may be the best treatment course if your child doesn’t have any other cartilage damage that needs immediate attention. Historically, young people up to age 11 who had a lot of growing left to do were managed nonsurgically because of concerns that surgery could affect future growth. This treatment approach includes physical therapy to strengthen the muscles that support the knee, like the hamstring and quadriceps.

The downsides to nonoperative management include:

  • Having to give up sports, particularly those involving side-to-side motions
  • Potential for additional irreparable damage every time the knee moves or shifts
  • Increased likelihood of debilitating arthritis as damage accumulates over time

Surgical treatment

Today, leading-edge techniques allow orthopaedic surgeons to operate without jeopardizing future growth. Surgical treatment for ACL injuries in youth athletes often makes sense because:

  • Youth athletes want to play sports and continue being athletic
  • Not repairing the tear can cause further damage
  • Without surgery there will likely be further damage to the ACL and other soft tissues in the knee

ACL tears are not like skin tears: They can’t be sewn back together and don’t heal on their own. The longer a patient lives with an ACL tear, the less likely it is that a surgeon can fix it. To repair an ACL, a surgeon has to reconstruct a new ligament. Two standard reconstruction options are:

  • Autograft: The surgeon takes tissue from that same knee and uses it to carefully construct the new ligament.
  • Allograft: The surgeon uses tissue from a deceased donor to make the new ligament. While this approach is faster and easier, allografts have a higher failure rate and a higher rate of additional surgeries for younger patients.

Is your child’s knee ready for surgery?

Before undergoing surgery, your child’s knee must be ready. Surgeons allow at least two weeks between when the injury occurs and surgery to repair an ACL. While children are anxious to get back on the field, waiting is vital to reduce the likelihood of complications.

Surgeons want to see that:

  • Swelling in the knee has reduced
  • The injured knee has full range of motion and can bend and straighten normally
  • Some of the muscle weakness that happened with the injury has gone away

Surgeons pay close attention to skeletal maturity when determining if a patient is ready to undergo surgery. They want to assess how much growth potential remains. The majority of growth in the leg comes from the growth plates around the knee — the end part of the thigh bone and the top part of the shin bone. Surgeons must be very careful not to disturb those growth plates during surgery.

In many cases, orthopaedic surgeons encourage youth athletes to go through “pre-hab,” which is an initial rehabilitation phase before surgery. Pre-hab reduces the rate of postsurgical complications. It may involve home exercises or working with a physical therapist or strength and conditioning coach.

After surgery, your child should begin physical therapy within days. Starting rehab right away delivers the best results.

Questions to ask your child’s orthopaedic surgeon

These questions can determine if an orthopaedic surgeon is the right one to treat your child:

  • How do you plan to treat my child’s injury? If you think surgery is necessary, which surgical reconstruction approach will you use?
  • Is my child done growing, and how do you know? If they are still growing, what steps will you take to minimize interrupting their future growth?
  • What can we do to prepare my child for surgery?
  • Do you recommend my child have pre-hab before surgery? Will they need home-based exercises, or do they require professional support?
  • How important is it for my child to start physical therapy rehab after surgery?

UCLA Health partners with the Orthopaedic Institute for Children to provide state-of-the-art pediatric orthopaedic care for a variety of conditions including ACL injuries.

The Center for Sports Medicine helps young athletes return to his or her sport quickly and safely.