ACL In Preadolescents: Should It Be Reconstructed??

Even though it is still rare, ACL tear in preadolescent athletes are more talked about and diagnosed. A lot more ACL tears in adolescents occur than in preadolescents. However, it is a huge problem to athletes with torn ACL. Whether or not to reconstruct the torn ACL in still controversial.

ACL connects two bone in the knee, femur and tibila, thigh bone and shine bone. It provides stability to the knee and keeps the shine bone from sliding forward on femur and it also prevents excess rotational movements of the knee. Without ACL, athletes will not be likely to perform athletic maneuvers 100% even though there are some who do.

In the preadolescent, their growth plates (physes) are open and still growing. Some doctors are not willing to operate in those athletes. They usually wait until a growth spur occurs to reconstruct the torn ACL. Because there are some reports that growth arrest or other complications may happen if they put a hole through growth plates. There are also reports that say that it is ok to put a hole through growth plates unless a hardware is left in the middle of them. 

There are a few methods to reconstruct ACL without drilling a hope in growth plates. One is to put a graft between epiphyes. Each end of the graft will not reach the growth plate and stopped before. Another way is to take an IT band and use is as a graft. Many orthopedic surgeons will wait until growth spur is finished to reconstruct the torn ACL. One problem that may occur is that leaving a torn ACL in the knee will likely lead to degenerative damage in the knee, thus, leading to premature OA (osteoarthritis). Think about 20 some year old female suffering from OA?! That is not easy. 


In the end, there is no perfect answer to this question, I believe. There are pros and cons either way, early reconstruction or delayed reconstruction. They all should be discussed by the doctor and family member including the injured athlete herself/himself.