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ACL Injuries in the Young Take Extra Time

That's because surgery is not recommended for those whose bones are still growing

(HealthDay is the new name for HealthScoutNews.)

SUNDAY, June 29, 2003 (HealthDayNews) -- To operate or not to operate? That is the significant question when it comes to treating anterior cruciate ligament (ACL) injuries in adolescents.

Traditional surgical procedure for an ACL tear involves drilling tunnels in the bone through the growth plate, which is located very near the knee joint in the ends of the femur (thighbone) and the tibia (shinbone). This isn't a problem for adults because the growth plate closes at the time of skeletal maturity -- when you're around 14 years old. But a child's bones are still growing, so damage to the growth plate can cause the tibia or femur to grow at an incorrect angle and produce a skeletal deformity.

According to Theodore Ganley, the orthopedic director of sports medicine at Children's Hospital in Philadelphia, the prevailing wisdom for dealing with injured kids in the 10-13 age range is the following: activity modification, counseling, exercises to strengthen the quadriceps and a brace, if necessary. Most important, the child needs to avoid high-level athletic activities that involve running, jumping and changing direction quickly, such as soccer and football. However, it's essential to prevent repeat injuries, and if this can't be done in a non-operative manner, surgical intervention might be considered.

"We hold kids off from surgery until they reach a bone age of 13 in girls and 14 in boys. That's just about a mandatory thing," Ganley said. "If your hand is forced and you have to do surgery, we use a procedure called 'going over the top,' which means you go around the back of the femur instead of going through a tunnel."

More information

For additional insight into ACL injuries and surgery, visit this informational site.

SOURCES: Theodore Ganley, M.D., orthopedic director of sports medicine, Children's Hospital, Philadelphia
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