Ask the Expert: Dr. Frank Cordasco, Orthopedic Surgeon, Answers Your Questions About Pediatric & Adolescent ACL Injuries
Q1. Which is better for ACL repair- cadaver or allograft? What is the recovery time after ACL repair? My daughter needs ACL repair during summer college break.
When the ACL tears, it has to be replaced with a graft in the vast majority of cases. The grafts come in two basic varieties: autograft, from the patient, and allograft sometimes referred to as “cadaver” graft. I use both types of grafts in my practice. My preference is to use autograft in the majority of my patients – particularly in the patients younger than 45-50. The recovery following ACL reconstruction in terms of return to sport at the prior level of activity is generally 6-9 months. The short term recovery is fairly quick: the surgery is an outpatient procedure, a brace and crutches are used during the first 2-6 weeks depending upon whether other injuries were sustained in addition to the ACL. Regarding your daughter and summer break: the majority of her recovery would be completed during her 10-12 week summer break. Upon return to college she would work with trainers or physical therapists to resume fitness and sporting activities.
Q2. Are ACL injuries more common in certain high school level sports than others?
ACL injuries occur in all sports that require rapid acceleration or deceleration, cutting and lateral movement: football, soccer, field hockey, basketball, volleyball, skiing, lacrosse, baseball, softball and racquet sports. ACL injuries are less common in track, cross country and hockey.
Q3. My daughter is a teenage soccer player. I recently saw on the web that females are more prone to ACL injuries – is this true?
There are gender-specific differences in ACL injury rates. Females under the age of 25 are 2-8 times more likely to tear their ACL than their male cohort.
Q4. How does an ACL injury in a child differ from an adult?
The difference in pediatric ACL injury relates to the type of surgical reconstruction. In children with open growth plates (those individuals who still have significant growth remaining), the ACL reconstruction has to be performed without compromising the growth plate. Standard adult-type reconstructions place small drill holes in the tibia and femur to allow passage of the graft. In the adult, the growth plate is closed and placing these small drill holes through the area is of no consequence. In the growing child this is not an option without the risk of creating a growth arrest or angular deformity. Historically, children were either not offered surgical treatment or treated with operations that avoided the growth plates but did not reproduce the anatomy as well as the adult-type reconstructions. At HSS we have developed a technique that restores the anatomy as well as an adult-type reconstruction without compromising the growth plate. This is termed an All-Epiphyseal ACL reconstruction using a hamstring autograft
Q5. My child injured his ACL playing lacrosse – will this have any affect on growth or other long term effects?
In general, complete ACL tears in children should be treated surgically to avoid recurrent instability of the knee and the potential for further injury to other structures such as the meniscus or articular cartilage. Depending upon the stage of growth the surgical options such as an All-Epiphyseal ACL reconstruction should minimize the risk of growth arrest, angular deformity or long term effects. Non-operative treatment is more likely to result in long-term effects in children who continue to engage in moderate to high risk sports with an ACL insufficient knee.
Dr. Frank Cordasco is an Orthopedic Surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery. The primary focus of Dr. Cordasco’s practice includes ACL and meniscus injury in the pediatric, adolescent, and adult athlete; shoulder instability; bicep tendon tears, rotator cuff and pectoralis tendon repairs, clavicle fracture surgery and AC joint separations. Dr. Cordasco’s research and education activities parallel and complement these clinical areas of expertise.