Pediatric ACL Tears

Pediatric ACL ruptures can occur as a result of various factors, including:

1. Sports Participation: Participation in high-demand sports activities, such as soccer, basketball, or gymnastics, increases the risk of ACL injuries in children and adolescents due to dynamic movements and sudden changes in direction.
2. Mechanism of Injury: ACL injuries in pediatric patients often result from non-contact mechanisms, such as planting and pivoting, hyperextension, or sudden deceleration forces applied to the knee joint.
3. Anatomical Factors: Anatomic variations, such as increased ligament laxity or alignment abnormalities, may predispose pediatric patients to ACL injuries.

1. Knee Pain: Children and adolescents with ACL ruptures often report acute or chronic knee pain, particularly with weight-bearing or physical activity.
2. Swelling: Swelling or joint effusion in the knee joint, particularly within the first few hours to days following injury, may indicate soft tissue damage and inflammation.
3. Instability: Patients may experience feelings of knee instability, giving way, or buckling, particularly during activities that involve cutting, pivoting, or jumping.
4. Decreased Function: Decreased knee function, such as difficulty walking, running, or participating in sports activities, may be observed due to pain and instability.

Diagnosing pediatric ACL ruptures typically involves a combination of clinical evaluation and imaging studies, including:

• Physical Examination: Assessment of knee stability, range of motion, and provocative tests to reproduce symptoms, such as the Lachman test or pivot shift test.
• Imaging Studies: MRI scans are the imaging modality of choice for evaluating ACL injuries, as they can provide detailed visualization of ligament integrity, associated soft tissue damage, and growth plate status.

ACL Repair

• Procedure: ACL repair involves reattaching the torn ACL tissue to its anatomical insertion site using sutures or suture anchors, with the goal of promoting healing and preserving native tissue.
• Indications: ACL repair may be considered in select cases of pediatric ACL ruptures with a proximal avulsion tear pattern and open physes, particularly in skeletally immature patients with significant growth potential remaining.
• Advantages: Preserves native ACL tissue, reduces the risk of growth disturbance or leg length discrepancy, and potentially allows for a more rapid return to sports activities.
• Considerations: Patient selection is critical, and ACL repair may not be suitable for all pediatric ACL injuries, particularly those with mid-substance tears or associated meniscal or chondral injuries.

Physeal-Sparing Techniques

• Procedure: Physeal-sparing ACL reconstruction techniques involve tunnel placement and graft fixation away from the proximal tibial and distal femoral growth plates, minimizing the risk of growth disturbance.
• Indications: Physeal-sparing techniques are preferred in skeletally immature patients with significant growth potential remaining, where ACL reconstruction is indicated to restore knee stability and function.
• Advantages: Reduces the risk of growth plate injury and subsequent growth disturbance, allowing for continued skeletal development and minimizing long-term complications.
• Considerations: Surgical technique and graft selection are critical to avoid physeal injury and optimize outcomes while maintaining knee stability and function.

Transphyseal Reconstruction:

• Procedure: Transphyseal ACL reconstruction involves tunnel placement and graft fixation across the proximal tibial and distal femoral growth plates, using techniques to minimize the risk of growth disturbance.
• Indications: Transphyseal reconstruction may be considered in skeletally mature adolescents or in cases where other surgical options are not feasible, such as mid-substance ACL tears or extensive ligamentous damage.
• Advantages: Provides stable fixation and reliable outcomes in adolescents with closed growth plates, allowing for timely return to sports activities with reduced risk of re-injury.
• Considerations: Close monitoring of skeletal growth and potential for growth disturbance is essential following transphyseal ACL reconstruction, particularly in younger patients with significant growth potential remaining.

Recovery from pediatric ACL ruptures depends on various factors, including the chosen treatment approach, surgical technique, and individual patient factors. Physical therapy plays a crucial role in postoperative rehabilitation, focusing on restoring knee strength, range of motion, and proprioception while protecting healing tissues and minimizing the risk of complications. Rehabilitation protocols are tailored to the specific surgical procedure and patient needs, with a gradual progression of exercises aimed at achieving a safe return to sports activities and optimizing long-term outcomes.