Pediatric anterior cruciate ligament (ACL) injury

What are the signs and symptoms of a pediatric anterior cruciate ligament (ACL) injury?

The ACL is one of the four major ligaments inside the knee, connecting the back of the thighbone with the front of the shinbone. The ACL stabilizes the knee while it pivots, so injuries can happen in sports with sudden cuts, jumps or twists like soccer, football and basketball.

We advise parents to treat ACL injuries as soon as possible, to avoid further damage and minimize pain and discomfort. ACL injuries are commonly linked with a “popping” sound followed by swelling.

Common causes of ACL injuries include:

• Stopping suddenly to change directions
• Slowing down while running
• Enduring repetitive impact from activities such as jumping, running or pivoting
• Experiencing forceful contact, such as a football tackle
• Landing incorrectly from a jump

Signs and symptoms can vary from child to child, though, and can include:

• Pain
• Swelling
• Tenderness
• Limited range of motion in the knee
• Discomfort walking

Risk factors

Girls — and especially female athletes — face a greater risk of ACL injury because of anatomical differences like pelvic width. Other causes can include muscle strength imbalance and problems landing.

How is a pediatric anterior cruciate ligament (ACL) injury diagnosed?

At the Andrews Institute, our experienced physicians start with a physical exam of your child’s knee to help determine if the ACL is torn. We may also order imaging scans such as an X-ray or MRI to confirm the diagnosis and look for other knee injuries.

Your child’s physical evaluation may include:

• Comparison of the injured and non-injured knees
• Tests to stress the knee and identify weak and possibly injured ligaments

Diagnostic testing may include:

• X-ray - Uses invisible electromagnetic energy beams to take detailed images of the bones of the knee, checking for any fractures
• MRI (magnetic resonance imaging) scan - Uses magnetic fields and radio waves to take detailed pictures of the knee joint, checking for tears in the ligaments and tendons

How is a pediatric anterior cruciate ligament (ACL) injury treated?

If your child is diagnosed with an ACL injury, we work with you to develop a comprehensive treatment plan.

Treatment options depend on several factors, including:

• Severity of the injury
• Age and skeletal development
• Activity level and desire to return to sports

For a mild ACL sprain, your physician may recommend initial treatment to reduce pain and discomfort and strengthen the muscles around your child’s knee.

Non-surgical treatment

• Activity modification
• Bracing
• Physical therapy (PT) and rehabilitation

Surgery

If the ACL is either partially or completely torn, we may recommend surgery.

• ACL reconstruction surgery - Surgeons use a piece of tendon from another part of a patient’s leg or from a deceased donor to repair the ACL tear.
• All-inside, all-epiphyseal ACL reconstruction (AE) surgery - If a physical exam or diagnostic test shows a patient is still growing, our surgeons use this advanced arthroscopic procedure to repair the ACL tear without disturbing skeletal growth or development.

Our expert pediatric surgeons use advanced techniques to protect your child’s growing bones. They also typically (whenever possible) take a minimally invasive, arthroscopic approach. 

Benefits of minimally invasive surgery include:

• Faster recovery
• Less pain after surgery (in most cases)
• Smaller incisions
• Earlier return to normal activities such as sports
• Shorter hospital stay
• Decreased infection risk

After surgery, our physicians work collaboratively with in-house physical therapists to create an individualized rehabilitation plan for your child’s unique needs.