As parents of young athletes, we know how passionate our children can be about sports, but we also understand the worry that comes when they face a serious injury, such as a torn ACL (anterior cruciate ligament). If your child, aged 8 to 13, has been diagnosed with an ACL tear and their growth plates are still open, you’re likely considering ACL reconstruction surgery. It’s essential to weigh the pros and cons, understand the recovery process, and know what the future holds for your child in sports.
What is Pediatric ACL Surgery?
Pediatric ACL reconstruction is a specialized procedure designed for young athletes whose growth plates haven’t fully closed. The ACL is a key ligament in the knee that provides stability during movements like jumping, cutting, and pivoting—essential activities for sports like soccer, basketball, and football. When the ACL tears, stability is compromised, which makes reconstructive surgery a crucial option for active kids.
Graft Options for Pediatric ACL Reconstruction
In pediatric patients, the surgeon has to select a graft that minimizes the risk of damaging growth plates. The two most common graft options are:
- Hamstring tendon autograft: This involves using part of the child’s hamstring tendon to reconstruct the ACL. It’s a strong and flexible graft that grows with the child.
- Allograft (donor tissue): This graft comes from a donor and eliminates the need to harvest the patient’s own tissue, reducing some immediate discomfort post-surgery. However, allografts may not heal as reliably in younger patients and tend to have slightly higher re-tear rates.
The choice of graft depends on various factors, including the surgeon’s experience, the child’s activity level, and the family’s preference.
Pros and Cons of ACL Surgery in Young Athletes
Pros:
- Improved stability: Surgery restores knee stability, allowing your child to return to sports without the risk of frequent knee buckling or giving way.
- Prevention of further injury: Leaving the ACL torn can lead to damage in other parts of the knee, like the meniscus or cartilage, which may lead to early arthritis.
- Continued physical activity: For highly active children, reconstructive surgery can help them resume their sports activities safely.
Cons:
- Growth plate injury: One of the major concerns in pediatric ACL surgery is the risk of damaging the growth plates, which could potentially lead to leg length discrepancies or angular deformities. However, surgeons are careful to use techniques that minimize this risk.
- Risk of re-injury: Kids are prone to reinjury due to their high activity levels and developing muscles. Proper rehabilitation and return-to-sport guidelines must be strictly followed to avoid a repeat tear.
- Psychological impact: A long recovery process can be difficult for kids who love sports, affecting their mood and motivation.
Will My Child Be Able to Return to Sports?
The short answer is yes, but it requires patience, a well-structured recovery plan, and strict adherence to return-to-sport guidelines. While most kids will return to their sport, they may need to modify their expectations, especially in the first year post-surgery. Following the rehabilitation protocol is critical to reduce the risk of re-injury.
What is the Recovery Timeline?
Week 1-2: The initial phase focuses on pain control, swelling reduction, and regaining knee motion. The child may need to wear a knee brace and use crutches for support.
Week 3-12: This phase focuses on gradually increasing knee range of motion, strength training, and balance work. Physical therapy sessions will be essential, with exercises to activate the quadriceps and hamstrings while protecting the new ACL graft.
Month 3-6: During this time, your child will progress to more functional activities like jogging in straight lines, low-impact plyometric exercises, and sport-specific drills. However, cutting, pivoting, or aggressive movement should still be avoided.
Month 6-12: Return to sport begins cautiously at this stage. Based on the surgeon’s assessment, physical therapists will gradually introduce higher-intensity exercises like lateral movements, cutting, and agility training. Full return to competitive sports typically happens around 9 to 12 months after surgery, depending on how well the knee has healed and the child’s ability to perform sports-specific movements without pain or instability.
Long-Term Concerns
One long-term concern after pediatric ACL surgery is the risk of developing early-onset osteoarthritis. Even with successful surgery, the knee joint has undergone trauma, which increases the likelihood of joint issues in adulthood. While the surgery can protect other parts of the knee from further damage, parents should be aware of this potential risk.
Another concern is the possibility of re-injury, especially in highly active children. Proper strength training, balance work, and neuromuscular exercises must be a part of the child’s long-term fitness routine to help prevent this.
Return to Sport Guidelines
Returning to sports too soon is one of the most common reasons for ACL re-injury. A few key milestones that should be met before considering return to sports include:
- Achieving at least 90% strength in the injured leg compared to the non-injured leg.
- Completing a battery of functional tests, including single-leg hop tests, shuttle runs, and agility drills without pain or instability.
- Emotional readiness: Feeling confident about the knee is just as important as the physical readiness. Your child should feel secure when making sharp turns, pivoting, or jumping.
Most children can return to sports between 9 and 12 months post-surgery, but your surgeon and physical therapist will make the final determination based on your child’s progress.
Conclusion: A Safe Return to Play
Pediatric ACL surgery offers young athletes a chance to regain their athletic potential, but it’s not without its challenges. Recovery takes time, and strict adherence to rehabilitation protocols is critical. The good news is that with proper care, most kids return to their favorite sports with full knee stability.
As parents, your role in ensuring a smooth recovery—encouraging rest, supporting physical therapy, and helping your child follow return-to-play guidelines—is vital to their long-term success. With the right approach, your child can get back on the field or court stronger and more resilient than ever.
Pediatric ACL Reconstruction vs. Waiting Until Growth Plates Are Closed
One important decision that parents face when their child sustains an ACL tear is whether to proceed with surgery immediately or to wait until the growth plates have fully closed, typically around age 14 to 16 for girls and 16 to 18 for boys. Here’s a comparison of both approaches:
Immediate ACL Reconstruction in a Pediatric Patient
When a child undergoes ACL reconstruction while their growth plates are still open, the procedure is adapted to minimize the risk of damaging these growth plates, which are responsible for continued bone growth. Surgeons use specialized techniques and tools to avoid or minimize growth plate disturbance, allowing the child to continue growing normally after surgery.
Advantages of Immediate ACL Reconstruction:
- Prevention of further damage: A torn ACL leads to instability in the knee, making the child more prone to meniscus tears, cartilage damage, or early arthritis. Early surgery can protect the knee from further injury.
- Faster return to sports: For active children, immediate reconstruction allows them to return to sports safely after rehabilitation, rather than sitting out for several years while their growth plates close.
- Less impact on mental health: Young athletes often experience emotional distress when they are unable to participate in the sports they love. Early surgery may help mitigate these effects by getting them back to activity sooner.
Disadvantages of Immediate ACL Reconstruction:
- Risk to growth plates: Although modern techniques aim to avoid growth plates, there is a small risk that the surgery could affect bone growth, leading to leg length discrepancies or angular deformities.
- Higher re-injury risk: Younger athletes are at a higher risk of re-injuring their ACL, particularly if they return to sports too soon or if their rehabilitation isn’t fully adhered to.
Waiting Until Growth Plates Close
In some cases, surgeons may recommend waiting until the child’s growth plates are closed before performing ACL reconstruction. This option is typically chosen for less active children or when the family is concerned about potential risks to growth plates. During this waiting period, the child would need to avoid sports that involve cutting, pivoting, or jumping to protect the knee from further injury.
Advantages of Waiting:
- No risk to growth plates: Once the growth plates have closed, there’s no risk of affecting bone growth during surgery, making the procedure technically less complicated and removing the concern about future leg length discrepancies.
- More robust surgical techniques: Surgeons can use the same ACL reconstruction techniques that are typically performed on adults, which may provide a stronger, more stable result.
Disadvantages of Waiting:
- Delayed return to sports: By waiting until growth plates are closed, children may be sidelined for 1 to 3 years, which can have a significant impact on their athletic development and mental well-being.
- Increased risk of knee damage: Without ACL stability, the knee is more vulnerable to additional injuries. Meniscus tears, cartilage damage, and even early-onset arthritis are potential complications of delaying surgery.
- Reduced muscle development: Sitting out of sports for a prolonged period can lead to muscle atrophy, reduced coordination, and diminished performance when the child eventually returns to play.
Making the Best Choice for Your Child
The decision to proceed with pediatric ACL reconstruction or wait until the growth plates close depends on several factors, including your child’s age, activity level, and the extent of knee instability. If your child is involved in high-risk sports like soccer, basketball, or football, early surgery may help prevent additional damage to the knee and allow for a safe return to sports after recovery.
Ultimately, the goal is to protect your child’s knee health while considering their long-term athletic and physical development. Your orthopedic surgeon will help guide you in making the best decision based on your child’s individual situation.
Want to Learn More About Your Child’s Return to Sport?
For a deeper dive into the realities of getting back to sports after ACL surgery, check out our other blog post: The Reality of Return to Sport: A Comprehensive Guide. It provides additional insights and expert advice to help you navigate the challenges of the recovery process.
If you’re ready to get started on your child’s road to recovery, book an appointment with us today to develop a personalized rehabilitation plan and ensure a safe and successful return to their favorite activities.
