Role of Bone Age in ACL SurgeryChildren and teens who watch sports know that injured athletes are treated and get back on the field quickly. Even players with more serious injuries, like anterior cruciate ligament (ACL) tears, can sometimes return before the end of the season. With this model in mind, young athletes are surprised to find it doesn't work that way for them.
Doctors are hesitant to reconstruct a torn ACL in a patient whose growth plates haven't sealed yet. Anything that disrupts the growth plate (called the physis) can stop bone growth, possibly resulting in a shorter limb or some other bone deformity. There's also the concern that ligament repair with an open physis puts the knee at risk for future injury.
In this study, 13 teenagers with open physes and ACL tears were followed. Surgery to reconstruct the ACL was delayed until bone formed over the growth plates. During the waiting time, activities were severely restricted. The teens could not play in team sports. Conditioning exercises were okay. Rehab to work on knee motion and strength were also approved. All of them wore a knee brace during their waking hours.
The researchers later measured the differences in injury rates between teens with delayed ACL reconstruction and those who had the surgery right away. There were some injuries in both groups, but they were equal in number, type, and severity.
The authors conclude that an ACL injury in youth isn't an emergency. Surgery can be delayed until the bones mature without risking further knee injury. The key is to restrict jumping and twisting activities and to protect the knee with a brace. They report that age doesn't seem to make much difference. There may be some greater risk of complications after surgery if the operation is delayed too long, however. In this study all ACL tears were reconstructed within one month of bone maturity.
G. William Woods, MD, and Daniel P. O'Connor, PhD, PT, ATC. Delayed Anterior Cruciate Ligament Reconstruction in Adolescents with Open Physes. In The American Journal of Sports Medicine January/February 2004. Vol. 32. No. 1. Pp. 201-210.
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