Can Your Child Have ACL surgery?

The ligament in the middle of the knee (shinbone) is one of the most important ligaments in the body. Ligaments are elastic bands of tissue that connect bones and give a joint its stability and strength.

One of the most common ligaments that can sustain injuries in children is the anterior cruciate ligament (ACL), which regulates the tibia's rotation and forward motion. 

Studies have shown that children who have gradually suffered an anterior cruciate ligament injury have a survival rate of 60% to 100% because ACL injuries usually have long-term consequences.

It is important for all parents to monitor their children's movements, especially if they participate in athletics, gymnastics, or other sports.

If there is severe pain in the child's foot and a change in the color of the foot, parents are advised to take their children to see a doctor for  ACL surgery.

According to Dr. Timothy M. Bradley, MD, FABOS, here are some ACL surgeries they should expect to discuss with us at POBAR.

Types Of Surgical Procedures For ACL Injuries In Children

ACL surgery involves procedures that physicians use to replace torn ligaments in the knee. Yes, children can also have surgery for an ACL injury. These treatment options aim to re-stabilize your child's knee to give them the full range of motion they had before the injury. 

Of course, some limitations come along with these surgeries. It’s no wonder it’s crucial to engage facilities that have been handling these procedures for a long time.

Most pediatric surgeons recommend surgical reconstruction once they confirm an ACL tear. They use grafts in ACL surgeries:

Autograft

The patellar tendon graft has long been the gold standard for anterior cruciate ligament (ACL) reconstruction.

This innovative surgical technique, in which the physician uses a tendon from another part of the body, such as another knee, the thigh, or the hamstring, is most effective for younger, active patients.

The patellar tendon graft (PTG) consists of a strip of tendon and attached bone fragments at the end of the patella and the tibial tuberosity.

This type of graft is designed to prevent the tibia from pushing too far forward under the femur, thus preventing abnormal rotation of the knee.

Orthopedic surgeons prefer the patellar tendon because it is the strongest ACL graft, is easy to access due to its location, and generally heals quickly. The graft allows rapid healing by creating a strong connection when a new graft is inserted.

When bone-on-bone contact occurs, the body treats the contact of the two surfaces as a broken bone and responds by healing the two surfaces together, fixing the tendon graft in place.

Another autografting method is hamstring autografting. Hamstrings are associated with better extension and extensor strength, which equates to a lower incidence of postoperative arthritis.

However, studies have shown that this procedure may increase children's risk of recurrent ACL injury. In hamstring autografting, a living donor hamstring tendon from a parent is used through a relatively small incision in the skin.

Autografts are known to be highly effective, with recent studies finding their failure rate to be the lowest at 6% to 7%.

Allograft surgery

ACL reconstruction by allograft is a surgical tissue graft replacement of the anterior cruciate ligament to restore its function after an ACL injury.

In this procedure, tissue is harvested from a cadaver (a deceased donor) and used to create a new ACL. Before the doctors implant the graft through a single incision hole, they remove the torn ligament from your knee.

Arthroscopy is performed during the procedure. 

Common allografts for ACL reconstruction in children include the patellar ligament, Achilles tendon, and anterior and posterior tibial muscles.

Allograft grafts have grown popular in recent years because there is no donor morbidity, meaning the doctors don’t harvest a patient's tendons for repair, sparing the patient with any additional surgery.

Our physicians point out that the allograft method is easier because there is less risk of stiffness after surgery, which can result from additional knee impairment after harvesting the repair tissue.

This method has a shorter operation time and a more reliable graft size. The results of this method are good, and the failure rate is low at 5.5%.

However, the failure rate in younger patients has increased to 23%, so this method is not as effective as autografting, despite having less pain.

Synthetic Graft Surgery

The so-called artificial graft has been in use since the beginning of the 20th century, with scaffolds, stents, and even silk and silver fibers serving in the treatment of torn cruciate ligaments.

They have been ideal graft substitutes. Artificial ligaments have fascinated surgeons for years because they offer the possibility of using more readily available and durable grafts than "off-the-shelf" soft tissue grafts.

In addition, they reduce disease transmission. While synthetic graft materials are controversial, they are an alternative transplant method for severe cases in children, except for their high failure rates.

Recovery time for operations

Autograft recovery generally takes about nine months, but it can take up to 12 months to fully recover and return to sports.

During the first few weeks, your child must do physical therapy to strengthen the muscles around the knee and improve flexibility. It is important so they can regain the same range of motion as the other knee. 

However, children cannot play sports for up to 9 months after an autograft. On the other hand, for adults, hamstring autograft does not affect fitness and their ability to drive 4 to 6 weeks postoperatively.

If the left knee is involved, driving should be resumed when reaction times have normalized, usually after a week.

Exercises to promote solid tendon graft healing into the bone facilitate early rehabilitation and a quick return to full activity. The muscles must gradually adapt to the increased load by twisting, accelerating, and decelerating.

It takes children about 9-12 months to return to full participation in sports after allograft surgery. On the other hand, adult patients can return to driving as early as 13-10 days after reconstruction.

Autograft, allograft, and synthetic graft are common surgeries used to treat knee injuries in children. Autograft is the most effective because it heals quickly, followed by allograft, which is less painful than synthetic grafts.

According to our experts, ACL injuries are the most successful considering the percentage of successes and failures, which is too low.

We invite you to visit our premises and learn about the treatment options that you can pursue. Your youngster's legs will thank them. While at it, don’t hesitate to ask as many questions as possible, and our experts at POBAR will happily respond to you.