Paediatric ACL Reconstruction

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What is paediatric ACL reconstruction?

The Anterior Cruciate Ligament (ACL) is a tough, fibrous, rope-like structure located in the centre of the knee. In children, ACL rupture treatment varies from that used in adults as a result of the presence of growth plates in the knee.

Indications and contraindications for paediatric ACL reconstruction

Paediatric ACL reconstruction is, typically, used for:

Complete ACL tear: particularly where the tear has resulted in significant knee instability.

Recurrent knee instability: where non-surgical treatment is unsuccessful.

High-activity patients: where involvement in sports or other recreational activity requires good knee stability.

Contraindications for paediatric ACL reconstruction include:

Open growth plates, where the risk of growth plate damage is high.

Absence of functional impairment.

Active infection.

Poor general health, including serious comorbidities.

Benefits and complications of paediatric ACL reconstruction

Benefits

ACL reconstruction can restore knee joint stability, reducing the risk of recurrent instability.
Reduced pain and discomfort.
Good functional recovery hysical activities that demand a stable knee joint, contributing to an improved quality of life.
Can reduce the risk of secondary injury, including meniscus or cartilage damage.
Supports knee joint longevity by reducing risk of osteoarthritis and degenerative change.

Known complications

Post-operative infection
Wound dehiscence.
Nerve injury, proximal to the harvest area.
Stiffness and limited range of motion.
Scarring.
Growth plate damage.
Graft failure.

The surgery

At the time of injury, steps should be taken to limit any additional damage by avoiding weightbearing on the affected leg, and icing to reduce swelling whilst medical assistance is sought. The growth plates of the knee are vulnerable, and damage can prevent further bone growth. In children, the growth plates are located at the same point at which the surgical holes for ligament attachment would be drilled in adults. Thus, paediatric reconstruction requires an alternative technique.

Often, conservative treatment may be used to treat the symptoms of damage until skeletal maturity is reached and the growth plates harden, at which a standard ACL reconstruction can be performed. Where this is not possible, reconstruction relies on arthroscopic use of soft tissue grafts from the child’s own body, rather than a donor.

Preparation prior to surgery

You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery. Functional deficiencies will be assessed; additional nueromuscular testing may be completed. Potential donor muscles are selected.
Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility.

On the day of the surgery

You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
The surgical site will be prepared.
You will be administered general or regional anaesthesia.
Several small incisions will be made around the knee through which the arthroscope and instruments are passed.
A graft is harvested from the back of the knee and prepared.
Small tunnels are drilled to accomodate the graft, avoiding the growth plate or, alternatively, the graft is passed around the knee, circumventing the growth plate altogether.
The incisions are closed with sutures, and sterile dressings are applied.

After your surgery

Wound care: your incisions will be closed with sutures and covered by a waterproof dressing. You may clean the wound gently with warm water and soap, being careful to dry it thoroughly.
Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum).
Mobilising: no immobilisationi is required.
Aftercare: At 1 week after your surgery, it will be neccessary to complete a wound checl. At Week 2, you may have the sutures removed. After 6 weeks, you will be asked to complete further checks to assess healing, and at three, six and twelve months after your surgery for the same reason.
Physiotherapy: a tailored program will help you to build strength, flexibility and mobility around your newly transferred tendon.

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

This treatment could be eligible for our No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team.