Pediatric Anterior Cruciate Ligament Reconstruction Surgery

The anterior cruciate ligament (ACL) is one of the four major ligaments of the knee, particularly a ropelike structure in the center of the knee that helps maintain the normal stability. Unfortunately, a torn ACL does not heal and the knee will typically continue to be unstable (shifts or gives way) during sports that require pivoting, changing direction (cutting), jumping, or landing. Even with restriction of risky activities, living everyday life without reconstructing the ACL places abnormal stresses on the meniscus of the knee resulting in tears and accelerated degeneration of the cartilage and arthritis. The diagnosis of an ACL tear is usually made on physical examination, though an MRI can be helpful to demonstrate the tear as well as other injuries to the meniscus and cartilage. ACL tears are becoming increasingly more prevalent in young athletes.

During ACL surgery, the torn ligament is replaced (reconstructed) with a graft, because simple repair usually is not possible. Common grafts used to replace the torn ligament include the hamstring tendons, bone-patellar tendon-bone, quadriceps tendon, or allografts (from cadavers). Dr. Chudik prefers to use the patient’s own hamstring graft as this has shown better long-term results with a lesser risk for arthritis. The goals of the surgery are to reconstruct the torn ligament, repair any other damaged structures including the meniscus or cartilage, and restore function and stability to the knee. Normal ACL surgery requires the graft and hardware to cross over the growth plates in both the femur (thigh bone) and the tibia (shin bone).

In young patients with significant growth yet to occur, this can potentially cause growth abnormalities. Dr. Chudik has developed a special procedure to reconstruct the ACL without injuring physis (growth plate). This procedure does not cross the growth plates and therefore, minimizes the risk for affecting growth.

Dr. Chudik performs ACL surgery with the assistance of an arthroscope (small camera that lets him look inside the knee through small incisions). The torn ACL is replaced by a graft. During the surgery, the other ligaments, meniscus and cartilage of the knee are evaluated and treated appropriately. Arthroscopically, the torn remnants of the ACL are preserved, bone tunnels are created in the tibia (shinbone) and femur (thighbone), without crossing the growth plate, and the graft is placed anatomically where the injured ACL used to be. The graft is held in position with special fixation devices that usually do not need to be removed.