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What are Anterior Cruciate Ligament Injuries in Adolescents?

Anterior cruciate ligament (ACL) injuries in adolescents are defined as damage or tear of the anterior crucial ligament in children between 10 and 19 years of age most commonly during sports and exercises. Ligaments are tough bands of tissue that connect one bone to another bone. The anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize the knee joint. Any injury to this ligament can seriously compromise knee function and overall quality of life. Additionally, children with ACL injuries have an increased risk of further injury, along with the risk for meniscal tears and early-onset osteoarthritis.

ACL injuries most often occur during sports activities that involve pivoting, cutting, and turning movements as in football, soccer, skiing, tennis, and basketball. Moreover, teenage girls are more likely to injure their ACL than teenage boys. The cause for this may be differences in anatomy, muscle strength, coordination, and hormones.

Causes of Anterior Cruciate Ligament Injuries in Adolescents

Anterior cruciate ligament injuries in adolescents are mostly sports-related injuries that occur when the knee is forcefully twisted or hyper-extended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.

Signs and Symptoms of Anterior Cruciate Ligament Injuries in Adolescents

When you injure your ACL, you might hear a “popping” sound and you may feel as though the knee has given out. Within the first two hours after injury, your knee will swell, and you may have a buckling sensation in the knee during twisting movements.

Diagnosis of Anterior Cruciate Ligament Injuries in Adolescents

Diagnosis of an ACL injury is made by a thorough review of your symptoms and medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scan, a stress test of the ligament, and arthroscopy for a detailed evaluation of the soft-tissue structures and to confirm the diagnosis.

Treatment for Anterior Cruciate Ligament Injuries in Adolescents

Treatment options include both non-surgical and surgical methods. If the overall stability of the knee is intact, your doctor may recommend non-surgical methods. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.

Young athletes involved in pivoting sports will most likely require surgery to safely return to sports. The usual surgery for an ACL tear is an ACL reconstruction which tightens your knee and restores its stability. Surgery to reconstruct an ACL is done with an arthroscope using small incisions. Your doctor will replace the torn ligament with a tissue graft that can be obtained from your knee (patellar tendon) or hamstring muscle. Following ACL reconstruction, a rehabilitation program is started to help you to recover and resume a wider range of activities.

However, surgical treatment of ACL tears in children is more difficult than in adults. This is because of fear of damaging the growth plate, present in bone ends above and below the knee in children. A traditional ACL tear repair involves the drilling of tunnels into the thigh and shin bones at the knee joint to replace the damaged ACL with graft tissue. With the growth plate in the path of these drill holes, the traditional reconstruction procedure may lead to growth abnormalities such as unequal lengths of the two legs. The younger the child, the more severe the possibility of deformity.

To lower the possibilities of growth arrest, alternative surgical techniques have been designed. One procedure involves drilling holes that go around the growth centers instead of passing through them. Another procedure involves avoiding holes altogether and wrapping the graft around the bones instead.

Preventive Measures for Anterior Cruciate Ligament Injuries in Adolescents

Some of the measures that are to be followed to prevent ACL injuries in adolescents include:

  • Follow an exercise program to strengthen the muscles.
  • Gradually increase your exercise level and avoid overdoing the exercise.
  • Ensure that you wear properly-fitted protective gear such as knee guards and pads, comfortable clothes, and athletic shoes before playing any sports which will help to reduce the chances of ACL injury.
  • Make sure that you follow warm-up and cool-down exercises before and after sports activities. Exercises will help to stretch the muscles, increase flexibility, and reduce ligaments and other soft tissue injuries.
  • Avoid exercising immediately after eating a large meal.
  • Maintain a healthy diet that will nourish the muscles.
  • Learn all the rules of the game you are participating in.
  • Avoid playing when you are injured or tired. Take a break for some time after playing.
  • Ensure that you are physically fit to play the sport.
  • American Orthopaedic Society for Sports Medicine
  • American Association for Hand Surgery
  • American Academy Of Orthopaedic Surgeons
  • The American Board of Pediatrics
  • North American Spine Society
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