Overview
Anterior Cruciate Ligament
Although common in adults, anterior cruciate ligament (ACL) injuries can also occur in children and adolescents, particularly those involved in sports like soccer, basketball, or gymnastics. Paediatric ACL injuries pose unique challenges because children’s bones are still growing. Here’s an overview of key considerations:
Growth Plates
Open growth plates (physes) around the knee joint are a major concern when treating ACL injuries in children. Growth plates are areas of developing tissue at the ends of long bones and are vulnerable to surgery damage. Injury or improper treatment could lead to growth disturbances, leg length discrepancies, or angular deformities.
Diagnosis
Symptoms: Pain, swelling, instability (the knee “giving way”), and difficulty bearing weight on the affected leg.
Knee Instability or Giving Way
– If the knee feels unstable or gives out during activities like walking, running, or jumping, this can be a sign of an ACL injury. A child may feel as though the knee cannot support their weight.
Significant Swelling
– Rapid swelling within a few hours of the injury suggests internal bleeding in the joint, which can be a sign of a ligament tear. This is especially concerning if the swelling is accompanied by severe pain.
Inability to Bear Weight
– If the child is unable to put weight on the affected leg or experiences intense pain when trying to walk or stand, this is a red flag that needs immediate medical attention.
Popping Sound at the Time of Injury
– Hearing or feeling a “pop” at the moment of injury is a common sign of an ACL tear. If the child describes this sensation, it is important to consult a healthcare provider.
Limited Range of Motion
– Difficulty bending or straightening the knee fully due to pain, swelling, or mechanical blockage (such as a torn meniscus along with an ACL injury) is a reason to seek a medical evaluation.
Prolonged Pain
– If knee pain persists for more than a few days after a fall or sports injury, even if it’s not severe, it is important to see a doctor to rule out serious ligament damage.
Visible Deformity or Bruising
– If there’s visible deformity around the knee joint or significant bruising, this could indicate a severe injury, potentially involving not just the ACL but other structures in the knee.
Recurrent Episodes of Instability
– If the child repeatedly experiences knee instability, with or without a major traumatic event, they should be evaluated for underlying ligament damage, including a possible ACL tear.
Physical examination:
Common tests include the Lachman test, anterior drawer test, and pivot-shift test to assess knee stability.
Imaging:
MRI is typically used to confirm an ACL tear, as it provides detailed images of soft tissues and can detect associated injuries (meniscus tears, cartilage damage).
Non-Surgical vs. Surgical Treatment
Non-Surgical: In younger children with partial tears or those with lower activity levels, conservative management like physical therapy and bracing may be considered. However, it may not fully restore stability, especially in active children.
Surgical: In cases of a complete tear or high activity levels, surgery is often recommended to restore stability and prevent further damage to the knee. Pediatric ACL surgery is typically modified to avoid damaging growth plates, using techniques such as physical-sparing reconstruction.
Recovery and Rehabilitation
Recovery from an ACL injury or surgery involves a lengthy rehabilitation process that focuses on:
- Reducing swelling and pain.
- Restoring range of motion and strength.
- Rebuilding neuromuscular control to prevent re-injury.
- Gradual return to sports, often taking 6-12 months depending on the severity of the injury and the treatment approach.
Risk of Re-Injury
Unfortunately, young athletes are at a higher risk of re-tearing the ACL, particularly if they return to sports too early. Ongoing conditioning, strengthening, and sport-specific training are crucial to prevent further injuries.
When to see a doctor?
With proper treatment, most children and adolescents can return to their pre-injury level of activity. However, there is an increased risk of developing osteoarthritis later in life, even after successful treatment.
Early evaluation can prevent further damage to the knee and help develop an appropriate treatment plan, which may include imaging like an MRI to confirm the diagnosis. Best orthopaedic surgeons in Pune plays an important role in diagnosis and planning the treatment.