The anterior cruciate ligament (ACL) is one of the four ligaments that hold the knee joints together. An injury to the ACL is serious because this type of ligament has very little capacity for healing itself once it is torn.
An ACL tear often occurs during sports like soccer, basketball, volleyball, hockey, skiing, gymnastics, football and wrestling where players often pivot, jump, and/or turn quickly. Because of differing anatomy and other reasons that are not yet fully understood, girls are two to six times more likely to experience an ACL tear for each hour they play sports compared to boys. However, because boys play sports more often and more frequently than girls do, a larger number of boys in the population have experienced ACL tears.
What are the symptoms of an ACL tear?
Often, the knee gives out and there is an audible “pop” or “snap” in the knee. Sometimes players must be helped off the field or court. The knee usually swells and causes pain. Because x-rays are often the test of choice to evaluate knee injuries and ACL tears are not readily apparent on x-rays, ACL tears are sometimes misdiagnosed as knee sprains.
How is an ACL tear treated?
For the first two days, the R.I.C.E. (rest, ice, compression, elevation) treatment should be followed. That is, the athlete should stay off the knee or use crutches. The knee should be iced several times per day. A knee brace should be used to compress and immobilize the knee joint. When the athlete is sitting or laying down, the knee should be elevated above the heart. The athlete may need to miss a few days of school to ensure R.I.C.E. treatment occurs. Tylenol with codeine, ibuprofen, or a prescription pain medication may be necessary.
While there are more conservative treatments that may be appropriate choices for your child, ACL reconstruction surgery is sometimes necessary. During ACL reconstruction, a tendon from another part of the body or from a cadaver donor is used as a substitute for the torn ACL. The surgery may be performed arthroscopically (involving small incisions through which surgical instruments are inserted) or open surgery (where a large incision is made in the knee.)
Like all surgery, ACL reconstruction has risks. The surgery involves crossing the growth plates of the lower and upper leg, which can result in growth disturbances leading to deformity or limb discrepancies. This is why in some cases surgeons may recommend delaying surgery if your child or adolescent is still in his/her peak growth spurt. After surgery, your child will be unable to participate in sports until the knee has healed and, before returning to sports, will need to undergo intensive physical rehabilitation.
However, without surgery, a person with a torn ACL is at risk for continued knee instability. Each time the knee gives out, the cartilage in the knee is at risk for increased damage, which is very difficult to repair and can lead to arthritis later in life.
About ACL reconstruction surgery at Children’s
The surgery for ACL tears is performed by the accomplished pediatric orthopedic surgery team at Children’s. Orthopedic surgery teams at Children’s provide next-generation care to children from throughout the Upper Midwest and consistently perform some of the most cutting-edge surgical procedures available, including minimally invasive surgery, when appropriate. ACL reconstruction surgery is performed at Children’s – Minneapolis, Children’s – St. Paul, and Children’s Minnetonka.
To make an appointment
To make an appointment at our clinic locations in Minneapolis or St. Paul, please call Children’s Orthopedic Clinic main line at 651-220-5700.