Treating ACL tears in children: When is surgery warranted?

Patients’ skeletal maturity and physiologic development are among factors to consider.

The number of pediatric patients who sustain anterior cruciate ligament (ACL) tears is increasing, especially among young athletes who participate in year-round sports that put tremendous strain on their joints. But how to treat these skeletally immature patients—whether with ACL reconstruction or nonsurgical treatments—remains controversial.

Jennie McKee, AAOS Now July 15 2015.

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Mininder S. Kocher MD MPH, associate director of the sports medicine division at Boston Children’s Hospital and professor of orthopaedic surgery at Harvard Medical School, explored both surgical and nonsurgical treatment options in young patients—focusing on the unique challenges that may occur when treating 12-year-old patients, specifically—during the 2015 Pediatric Orthopaedic Society of North America Specialty Day.

Weighing pros and cons
“It’s important to recognize that not all 12-year-olds are the same,” said Dr. Kocher. “Children of the same age may be at various stages of physiologic development.”

Advantages and disadvantages of both surgical and nonsurgical treatments should be carefully considered, he said.

“Surgical treatment can provide knee stability, which enables the child to return to sports and activities,” he said. “Surgery can also treat meniscal chondral injuries.”

Disadvantages of surgery, he said, include the fact the surgeon is performing a complex surgery in a young child. “In addition,” he said, “the long-term outcomes of surgery are unknown in children, and there is a risk of a growth disturbance.”

Nonsurgical treatments avoid these risks, but may increase the patient’s risk of meniscal chondral injury and subsequent knee instability.

“In addition,” said Dr. Kocher, “nonsurgical treatment restricts activity in these young active patients, which has a psychosocial impact.”

Source AAOS Now, American Academy of Orthopaedic Surgeons

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Treating ACL tears in children: When is surgery warranted? Jennie McKee, AAOS Now July 2015. American Academy of Orthopaedic Surgeons.

Also see
Contributors to pediatric ACL surgery outcomes in Lower Extremity Review

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