ACL Injuries in Young and Growing Athletes
Jesus Melgoza age 13 of Grand Prairie
Jesus knows first-hand about soccer injuries at a young age. He was twelve years old when he injured his left knee. His injury occurred without contacting another player or the ground. This is referred to as a non-contact injury and most often occurs when the foot is planted on the ground and the body twists the knee. Jesus described the moment it happened using the words “twist” and “pop.” His knee swelled immediately and it stayed swollen for the first few days after the injury.
This is a very typical history for an anterior cruciate ligament (ACL) injury in the knee for both young athletes and adult athletes. The ACL is a thick rope-like ligament inside the knee and is considered the primary stabilizer in the knee. Without a healthy ACL, the knee may become unstable and be at risk for other injuries.
What makes the injury unique for a young athlete like Jesus is the fact that the bones are still growing. At the ends of the leg bones near the knee are open growth plates filled with soft tissue called physes (pronounced fahy-sis). Over time, bone cells develop in these areas and make the bones longer. Eventually, bone replaces the cartilage. This is when the growth plates “close” and growing stops.
An ACL injury doesn’t directly disrupt these growth plates, but the standard treatment for an adult would impact growth. Therefore, special considerations are made when considering treatment of a torn ACL in a growing athlete.
First, not everyone needs surgery for a torn ACL. Therefore, it is important to review the athlete’s plan for returning to sports including which sport, desired level of competition, and long term future planning the sport. Secondly, any decision regarding surgery with open growth plate must consider future problems with the growth plate and the risk for a repeat injury to the ACL.
Research at our institution has found that delaying treatment increases the risk of additional problems inside the knee joint. Most of the delays in the study were from not going to the doctor immediately for evaluation and treatment and opting to wait for surgical reconstruction. Continuing to play with knee instability may lead to damage to the meniscus or other soft tissues in the knee. In some cases, a brace and physical therapy may be sufficient to protect the knee from further damaging movements. However, many young athletes are choosing to proceed with reconstructive surgery. The procedure is performed using minimally invasive arthroscopic techniques. For patients like Jesus, a portion of the hamstring and the iliotibial band may be used to completely replace the torn ACL, minimizing damage to the growth plates.
Though the procedure is the first step, successful return to sports is dependent on the athlete’s participation in a rehabilitation program, mental readiness and completion of certain physical tests. These help to prepare and assess the athlete to determine when returning to sports is safe.
Though some injuries cannot be prevented, non-contact injuries are thought to be preventable. Many studies have focused on this concept and there is promising data to suggest there are ways to prevent ACL injuries in young athletes. For more about pediatric sports medicine and injury prevention, please visit our website at scottishritehospital.org/sports
What to Expect with Knee Arthroscopy, Texas Scottish Rite Hospital Sports Medicine
Dr. Henry B. Ellis is a pediatric orthopedic surgeon at Texas Scottish Rite Hospital for Children. He is dual fellowship trained in pediatric orthopedics and orthopedic sports medicine and leads sports medicine research efforts at our institution and in collaboration with other pediatric hospitals throughout the nation. As a team physician for the U.S. Ski and Snowboard Team, Dr. Ellis provides event coverage internationally for elite athletes. As an Assistant Professor of Orthopedic Surgery at the University of Texas Southwestern Medical School, he trains future orthopedic surgeons in pediatric sports medicine and arthroscopy. Call: 469-515-7100