ACL Knee Injuries in Children

ACL Knee Injuries in Children

About ACL Injuries

Knee injuries can occur in active kids, specifically athletes, and a torn anterior cruciate ligament (ACL)– a ligament that assists offer the knee its stability– is among the most serious types of knee injuries.

Kids who get ACL injuries tend to play contact sports (like football and basketball) or so-called “cutting” sports (like soccer and baseball that feature swift, abrupt motions such as rotating, stopping, or turning on a penny).

The injury can likewise occur with specific movements, like when a child jumps and lands hard on his/her feet. If the quadriceps muscles aren’t strong enough, a movement an athlete is used to doing can suddenly put too much pressure on the knee joint, triggering the ACL, a rope-like band of tissue, to tear or disintegrate.

Teenage women are 2 to 10 times more likely than young boys to tear an ACL. That’s due to the fact that ladies have different risk factors that make ACL injuries more likely, such as body shape, limb alignment, neuromuscular control, and hormones that might loosen the ligament.

ACL injuries can be very painful, specifically during cutting and pivoting movements. Depending upon the age of the child and the severity of the injury, a torn ACL typically benefits best from surgery in addition to 6 to 12 months of rehabilitation. This treatment can help avoid a gamer from getting arthritis or more knee damage.

The most common kind of pediatric ACL injury is a complete tear of the ACL. Typically, surgery is indicated for these injuries. Surgical options for youth, teenagers and young people differ by the patient’s age and musculoskeletal maturity.

What an ACL Does

The ACL is among the four primary ligaments in the knee joint that connect it to the shinbone (tibia) and thighbone (femur). It is located deep within the joint, behind the kneecap (patella), above the shinbone, and listed below the thighbone.

Together with the PCL (posterior cruciate ligament), which crosses over it to form an “X,” the ACL assists keep the knee steady while rotating.

Particularly, the ACL keeps the shinbone in location and avoids it from moving too far forward and away from the knee and thighbone. It likewise supplies stability when rotating the shinbone.

Signs and Symptoms

Kids with a partly or completely torn ACL will definitely feel pain when the ACL tear takes place. Later, they may or might not have symptoms, depending on the seriousness of the injury.

The majority of will have no problems with walking. But if they return to their sport, they may have some instability, feeling “unsteady” or unable to bear weight on the affected leg. Often there is pain, which can be extremely extreme, and swelling of the knee joint, which can occur within 24 hours of the tear.

When the injury is taking place, numerous kids report hearing a “pop” sound– the noise of the shinbone popping out of and back into location. Others also report the knee feels “less tight” or less compact than it was before.

A child who has actually injured a knee– whether out on the field or at home– need to stop all activity (to avoid additional injury) and look for instant treatment. In the meantime, keep the area iced– put the ice in a plastic bag, cover the bag in a cloth, and hold it to the knee for up to 20 minutes at a time. Also, keep the knee raised as much as possible to minimize swelling. If putting weight on the knee is painful, a child should not bear weight on the knee.

ACL Knee Injuries in Children

Medical diagnosis

At the doctor’s office or emergency clinic, physicians will perform physical exams and imaging tests to figure out if there is a knee injury and, if so, how severe it is.

These tests can help detect an ACL injury:

  • Lachman test. During this exam, a child will rest flat on his or her back with the impacted knee lifted and flexed at a 20- to 30-degree angle. The doctor then positions one hand on the calf and the other on the top of the thigh, applying pressure to move the shin forward. If it moves too far forward, it can signal a torn ACL.
  • Anterior drawer test. During this test, the hip is flexed at 45 degrees and the knee at 90 degrees. The inspector comprehends the back of the shin, just below the knee, putting forefinger on hamstring tendons and thumbs on the side of the kneecaps to feel any shift of the knee joint and surrounding areas while attempting to pull the tibia forward.

To appropriately identify ACL injuries, doctors normally carry out these tests in mix with or in addition to other physical exams.

While X-rays might be taken to identify the level of the injury, they only image bone and, for that reason, can only validate the existence of bone fractures in the knee. An MRI, which images tissue (like ligaments and muscles), can validate a partial or complete ACL tear so some physicians will buy one to confirm a medical diagnosis.


Treatment of ACL injuries depends upon the age of the child and the kind of injury, however usually includes some kind of surgery. If a child is still growing, surgeons ensure not to touch the growth plates. Development plates are the developing tissue on the ends of long bones, like the tibia and femur. Kids who are still growing have “open” development plates, while those who have reached skeletal maturity have “closed” growth plates.

When a child stops growing, the development plate hardens (ossifies) in addition to the remainder of the bone. Ladies have the tendency to stop growing earlier than boys; their development plates usually surround ages 14 to 15, while kids’ development plates close later on, at around ages 16 to 17.

If a child has reached skeletal maturity, the surgeon will drill a little tunnel down through the thigh to reach the inside of the knee joint. Surgeons change the torn ACL with tissue from the patient’s own body (generally tissue from the main patellar tendon or hamstring) or with tissue donated from someone else (called an allograft). The new ACL tissue is put into the body through the tunnels created in the tibia and femur and is protected in the appropriate area with screws or other components.

If a child is young, cosmetic surgeons will use a strategy that spares the development plate. One example is iliotibial (IT) band reconstruction. The IT band is a thick band of tissue that covers the leg from the lower pelvis to the bottom of the shinbone. Tightening this tissue over the kneecap helps to stabilize the knee and avoid the tibia from moving too far forward.

After surgery, a child will need to walk with the assistance of crutches, limit exercise, and wear a full-leg brace for 4 to 6 weeks, depending upon what the cosmetic surgeon encourages.

Rehabilitation and Recovery

Recovery from ACL surgery is a prolonged process that can draw from 6 months to a year. Rehabilitation (” rehab”) therapy is had to assist recover the knee and to:

  • bring back series of motion
  • regain strength in the knee, thigh, and shin muscles (and avoid atrophy, the breakdown of muscle tissue)
  • reduce pain and swelling
  • improve balance

A lot of kids undergo rehabilitation at a center three times a week, with day-to-day exercises they practice at home. Accelerated rehabilitation programs involve more frequent therapy, but they won’t necessarily speed recovery.

In the early stages of recovery, a child might get a leg brace and subsequent knee brace, depending upon the cosmetic surgeon’s suggestions. Keeping the knee iced and elevated can help to decrease swelling. Medical professionals may recommend prescription painkillers and anti-inflammatory medication to assist kids handle the pain and feel more comfortable. Sometimes, medical professionals may give people steroid injections to relieve pain and help reduce swelling.

While most sports are off limits– especially the activity that caused the injury in the first place– kids can do some low-impact activities that may be enjoyable as well as healing, like swimming, bike riding, or safeguarded running. Speak to your doctor about what activities may benefit your child.

Helping Your Child Cope

Being informed that you cannot do the things you like– like running or playing football, field hockey, or softball– can be a devastating blow to any child. Kids recovering from an ACL injury might feel angry, frustrated, and even depressed, especially if they’re not participating in group sports with their good friends.

However in the meantime, there are ways to still feel like part of the group. Keeping score, being a coach’s assistant, or bringing water to the games may help. If your child does not wish to do these, recommend beginning a hobby, like playing the guitar, painting, drawing, or another activity that won’t put too much strain on the knee. Low-impact activities, like swimming, are another option.

In time, kids can return to the things they love. However if your child continues to feel mad or depressed during recovery, encourage them to speak to a school psychologist or counselor, who can assist your child cope and look ahead to better days.

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