Setting Expectations for Pediatric ACL Surgery Recovery

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As participation in youth sports has grown, so has the rate of injury. Dr. Ted Ganley, a specialist in pediatric ACL reconstruction, talks about how to balance a child’s torn ACL recovery with a family’s hopes and demands.

Participation in sports offers many benefits, from physical fitness and motor skill development to mental benefits like greater self-esteem, teamwork skills, stress reduction and socialization.

Tween girl playing soccer in front of net At the same time, organized sports are a leading cause of injury in children. As participation has grown — with more than 60% of American youth participating in organized sports — so too has the rate of injury. Each year, childhood sports account for more than 8 million injuries that require medical attention.

Pediatric anterior cruciate ligament (ACL) injuries are a prime example of this, says Theodore J. Ganley, MD, Director of the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia (CHOP) and a specialist in ACL reconstruction in elite athletes.

Year-round single-sport participation and early specialization in a sport has dramatically increased ACL injuries in the pediatric population. In a commentary recently published in the American Journal of Sports Medicine, Dr. Ganley discusses the increasing rate of serious sports injuries such as ACL tears in younger children and how to balance a child’s torn ACL recovery with a family’s hopes and demands.

How long does it take to recover from a torn ACL?

A generation ago, in many parts of the world, an ACL injury would likely mean the end of participation in team sports and put a child at risk for early cartilage and meniscus damage. Fortunately, there are now effective ways to stabilize the knee. Although not perfect, the current surgical techniques for ACL reconstruction, meniscal repairs and other soft tissue treatments are highly successful.

Surgery is just the beginning of a long road to recovery. After carefully reviewing the surgical risks and benefits, and even after a successful surgical procedure, there can be months of rehabilitation just to get back to exercising. Returning to higher-level sports is expected to take nine months for those who meet criteria to ensure that they have appropriate motion, strength and balance. For some patients, however, meeting the criteria can take between nine to 12 months; in others, it can take even longer. The physical and emotional burden of such an injury and recovery can be a lot, even for an adult, let alone an adolescent.

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While the postoperative rehabilitation is oftentimes not as strictly followed in younger athletes, the combination of state-of-the-art surgical techniques and impeccable recovery potential in this age group usually makes the initial surgery and recovery successful. There is a very high rate of pediatric athletes returning to sports following ACL reconstruction. However, even with this high rate of return to sports and the impressive number of hours of sports exposure in young athletes, there are high reinjury rates in pediatric athletes.

Managing families’ expectations for recovery after torn ACL surgery

Unfortunately, families’ expectations for their adolescent athlete’s recovery from ACL surgery can be misinformed, shaped by ideals established from stories they’ve seen about professional athletes.

After evaluating a child’s injury, Children’s Hospital of Philadelphia surgeons will meet with the patient and family to discuss the outcomes of each treatment strategy, the risks as well as the benefits of surgery, the rehabilitation ahead of them, the risk of a repeat ACL injury, and the long-term outcome of an ACL-reconstructed knee.

A few rare patients have expectations of returning to their sport in a few months with plans to play on multiple teams in collision sports year-round, however, our sports team notes that such an accelerated approach to recovery and return to sports could put their child at high risk of reinjury. The sports surgeons at CHOP suggest ways to limit the child’s chance of reinjury, including rehabilitation exercises that reinforce areas both inside and outside of the knee joint, altering the frequency and duration of pivoting sports, and, in some instances, even changing the child’s sport altogether. While surgeons can, at times, return athletes to the same sport, it is not always advisable to return at the same time interval, level and year-round commitment, or to multiple teams simultaneously.

Your clinician and the members of CHOP’s Sports Medicine and Performance program will discuss the most probable long-term outcome of each decision you and your family make and help you fully understand the issues at hand. In the end, the goal is to have the young athlete, the family and the physician agree on decisions that pave the way for the child to return to being a healthy, fit and happy athlete, hopefully for a lifetime.

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