Pediatric ACL Reconstruction

Our children, whose future remains our most precious commodity, are participating in organized sports at an increasing rate. In fact, in merely the primary and secondary school age population, 4.3 million children and adolescents suffer from sports related injuries annually, with 1.9 million of these classified as “serious injuries”. Complicating ACL reconstruction in the pediatric population is the presence of “open growth plates”- the centers through which your child’s bones grow. Traditional pediatric ACL reconstruction has attempted to restore the ACL through non-anatomic techniques to avoid damage to the growth plates. Contemporary science now allows the surgeon to perform an anatomic reconstruction while also avoiding damage to the child’s growth plates.

Patient Profile:

  • Children and Adolescents with ACL tears and open growth plates
  • Increasingly common sports injury, with increase in youth sports leagues

The ACL connects the femur to the tibia in the center of the knee joint. ACL tears are very common, especially as a consequence of sports activities. Even in a child or adolescent, ACL fibers cannot be repaired due to irreversible stretching damage at the time of the injury. It is estimated that over 100, 000 ACL reconstruction surgeries are performed in the US each year- many utilizing “non-anatomic” techniques. ACL reconstruction commonly involves placing a tendon graft where the original ACL used to be.

Anatomic pediatric ACL reconstruction refers to the concept of individualizing the specific surgery to match the unique anatomy of your child’s knee – thus avoiding injury to the growth plates while still placing the graft in the proper position. Anatomic landmarks and intraoperative fluoroscopy (live, real-time video xrays) are utilized to place the graft in the ideal anatomic position, while maintaining the integrity of your child’s growth plate. This technique is superior to a “vertical graft” designed to minimize damage to the growth plate, as it avoids the growth plate altogether. Furthermore, because the graft is placed in an anatomic position, this serves to better control rotational instability in the knee. Rotational instability after ACL reconstruction- the “pivot shift”- is a common cause of continued instability, meniscus tears, and cartilage injury more common after traditional pediatric ACL reconstruction. Avoiding these complications of non-anatomic pediatric ACL reconstruction will ensure the safety and health of your child when they return to sports.