In this month’s issue of the American Journal of Sports Medicine, authors from Kaiser Permanente in southern California looked at the effect of recurrent injury and surgical delay on meniscus and cartilage injuries in adolescent patients with ACL tears. Dr. Wilson’s thoughts on this article are below:
Treatment choices for adolescents with ACL tears have been a source of ongoing controversy. Adolescents are unique in the fact that their growth plates around the knee are still growing. This makes surgery around the knee difficult, potentially causing deformity as a child grows. Some authors have advocated waiting until the child is done growing to do ACL surgery. These growth plates are usually done growing by age 14 in girls and 16 in boys. While waiting until this age would be ideal, there are concerns for further injury in a younger patient (for example and 11 year old boy) who tears his ACL. Other research has shown that delay to treatment and continuing sports with a torn ACL can lead to further damage to the meniscus and cartilage in the knee. This type of damage can have significant long-term implications for overall knee health and potentially the possibility of early-onset arthritis.
This article suggested that waiting to do ACL surgery may not increase the risk of additional injury as some people have thought. In the end, the decision for whether or not to put a child or adolescent through an ACL surgery is a very complex one and depends on many factors; the patient’s age, activity level, symptoms and initial injury mechanism.
Thankfully, new techniques have made ACL reconstruction in the young patient safer and more effective. Even in spite of good results and slick new techniques, discussing ACL surgery in an adolescent remains a very difficult topic. These conversations are some of the most difficult I have with my young patients and their parents. The truth is, there are no hard and fast rules for the timing of ACL surgery in these kids and it needs to be a decision reached after many long heart to heart discussions between the family and a sports medicine expert. If a decision is made to go ahead with surgery, make sure your surgeon has experience with adolescent knee surgery and is skilled in the delicate techniques required.
Article for commentary:
Funihashi, K, et al. Anterior Cruciate Ligament Injuries in Adolescents with Open Physis. Effect of Recurrent Injury and Surgical Delay on Meniscal and Cartilage Injuries. American Journal of Sports Medicine. 2014;42(5):1068-1073.