The initial treatment consists of ice during the first 24 to 48 hours, elevation, rest, compression, such as an ACE wrap, and keeping the knee from moving by applying a knee brace. Crutches are usually needed. A pain medication, such as ibuprofen, hydrocodone or oxycodone, is often prescribed. The patient may have to miss a few days of school after the initial injury.
Most young athletes who want to continue playing sports, especially basketball, soccer, volleyball, football and wrestling, choose to have ACL reconstruction surgery. Without surgery, a person with a torn ACL is at risk for repeated knee instability. Each time the knee gives out, there is a risk of increased damage to the cartilage in the knee, which is extremely hard to repair and can cause arthritis later in life.
Because the ACL will not heal even if it is repaired, a nearby tendon is used as a substitute for the torn ACL tendon. This is why the procedure is called a reconstruction. An adult-style ACL reconstruction will go through the growth plates of the leg bone (tibia) and the thigh bone (femur). Children and teens who still have a lot of growth remaining in their knees are at some risk for a slowing of growth if standard ACL surgery is performed before they are finished growing. We have co-developed an “All epiphyseal” ACL reconstruction for children that restores normal anatomy and function but does not touch or cross the growth plates.
The chance of stopping a child’s growth after ACL reconstruction in young patients is a rare complication. Once a teen’s ACL is reconstructed, he / she can usually return to the prior level of sports competition without any more episodes of instability.
A pre-operative treatment program usually consists of:
- Aggressive rehabilitation with strengthening of the knee muscles
- Regaining range of motion
- Controlling swelling
A brace can be used for support; however, basketball, soccer, wrestling, football and volleyball should probably be avoided by patients awaiting reconstruction.