Health Information

ACL injuries

What are ACL injuries?

Your knee depends on strong ligaments to keep it stable. The anterior cruciate is one of two large ligaments that cross in the center of the knee joint. This ligament keeps the shinbone (tibia) from shifting forward under the thighbone (femur).

Sometimes a collision or twisting injury causes an injury to this ligament. When young athletes sustain this injury, they often describe immediate pain, and sometimes a popping sound. Swelling and an inability to continue playing immediately follow.

An X-ray will help us diagnose a fracture and determine whether growth centers are involved.

How we can help — treatment options

This injury occurs more commonly in older adolescents and young adults. In younger children, ligaments and tendons are stronger than growth centers.

For children and young adolescents who have open growth plates, orthopaedic surgeons at The Children's Hospital of Philadelphia recommend activity modification and rehabilitation. Sports such as soccer and football, which involve "cutting" — running with jumping, pivoting, and twisting — are not recommended in young patients with a deficient ACL. In patients who have reached skeletal maturity who have ruptured their ACL and desire to be involved in cutting and twisting sports, we may recommend several surgical options. We carefully analyze all the structures of the knee to choose the best method for each individual patient.

Anterior cruciate reconstruction is a surgical option for adolescents with more mature bones. Treatment for cruciate reconstruction involves surgical arthroscopy — with small incisions to create minimal trauma to the knee. A new ligament is used to replace the torn one. The high school or college athlete who has this procedure performed will need to be involved in a therapy program that is designed to regain motion and strength. Patients are not permitted to return to their sports until an appropriate level of strength and agility training is completed.

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