Young, Growing Athletes Should Not Put Off ACL Surgery

In some cases skeletally immature patients with anterior cruciate ligament knee injuries are advised to delay surgical treatment of the injury and wear a brace for activities until their bones have completed growth. The reason for this is the hypothetical risk of inducing a growth disturbance to the bones around the knee. This must be balanced against the more likely risk of further permanent knee damage by delaying surgical stabilization of the knee. ACL surgery can be done and should be done in young patients with open growth plates (skeletally immature-bones are still growing) to mitigate the risk of permanent damage to the knee. The surgical technique must be modified. The modifications include using a soft tissue graft and using graft fixation devices that do not cross the growth plate. Grafts must be placed anatomically. A study of 70 patients 14 years of age or younger by Theodore Ganley, M.D., J. Todd Lawrence, M.D., PhD and Nina Agrawal, BA concluded that delaying surgical treatment of these patients longer than 12 weeks resulted in a 4 fold increase of irreparable medial meniscus (loss of the medial meniscus greatly increases the chance of knee arthritis), an 11 fold increase of chondral (joint surface) injury in the lateral compartment, and a 3 fold increase in patellotrochlear chondral injury compared to the young athletes that had earlier knee ACL reconstruction. The noted damages in the non operative group occurred despite activity modification, bracing and continued knee rehabilitation. Their results highlight and quantify the risk of delaying ACL surgery in young athletes and emphasize the continued effort on injury prevention for young athletes.