ACL Injuries in Children: A Parent’s Guide to Understanding and Treatment

The primary difference between a child's and an adult's knee is the presence of open growth plates (or physes). These are areas of cartilage at the ends of long bones that are responsible for bone growth. A traditional ACL reconstruction, which involves drilling bone tunnels, could potentially damage these growth plates, leading to long-term growth complications. 

For a more detailed explanation of why treating a child's ACL is different, you can refer to resources from reputable hospitals like Boston Children's Hospital¹

The approach to treating a child's ACL injury must be carefully tailored to their specific level of skeletal maturity and the location of the injury.

The decision to pursue surgical or non-surgical treatment depends on several factors, including the child's age, activity level, and the extent of the injury. The Orthopaedic Innovation team prioritises ACL repair over reconstruction whenever possible, as it is less invasive and allows for quicker rehabilitation. They perform a thorough assessment of the entire knee joint during surgery to determine the best approach.

1. Non-Surgical Management

For younger, less active children, non-surgical management may be considered. This approach is often chosen to avoid the risks to growth plates, but it does carry the risk of future knee instability and potential damage to the meniscus and articular cartilage.

2. Advanced Surgical Techniques

For skeletally immature or highly active children, modern surgical techniques are designed to restore stability while protecting the growth plates.

• ACL Repair: In this technique, the surgeon repositions and secures the patient's existing ligament to allow it to heal naturally. This technique was pioneered by Professor Wilson and he was the first to perform it on children.
• ACL Reconstruction: If a repair is not feasible, a new ACL is created using a graft, typically from the hamstring or quadriceps tendon.

Our commitment to providing the best care for children with ACL injuries is led by Professor Adrian Wilson, an internationally recognised knee surgeon with specific expertise in this field. 

Professor Adrian Wilson is recognized as a pioneer in advanced ACL repair for children, having co-authored the first paper to present a pediatric ACL repair reinforced with a temporary internal brace. He holds the largest global experience with this specific technique in children and also patented the broader concept of using an internal brace to support ligament reconstruction. Read further on Adrian Wilson's profile. 

Leading the team, his/the Orthoapedic Innovation approach is highly personalised and involves:

• A thorough assessment: We evaluate not just the injury, but the child’s skeletal maturity, growth potential, current activity level and future athletic goals.
• Evidence-based decision making: We discuss all options with the patient and their family, ensuring the chosen path is the safest and most effective for their long-term knee health.
• Holistic rehabilitation: We provide a structured rehabilitation programme led by a physiotherapist that is crucial for recovery and ensures a safe, gradual return to sport.

Learn more about our approach on our Knee Treatments page.

The recovery journey from an ACL injury in a child requires patience and dedication. A well-managed rehabilitation programme is key. The timeline for recovery is dependent on whether a repair or reconstruction was performed and is typically longer than for adults, as the child's body needs more time to heal and grow. 

A return to high-impact sports is generally not recommended until the knee is fully stable and the child has regained full strength, which can take anywhere from 9 to 12 months, and often longer. This article from North Carolina Speciality Hospital² explains further.