My 11 year old daughter tore her ACL and Meniscus in a soccer tournament a few weeks ago.
I decided to blog about it for a couple of reasons:
- My friends and family are interested in following Jaeda’s journey.
- To help other clueless parents frantically scouring the web for tips and insights into fixing their child’s ACL.
Pediatric ACL Surgery Decisions
Here are the ACL repair decisions I’ve learned so far:
- Harvest site (for the donor tendon) – hamstring, patella, achilles, quadriceps, and iliotibial tendons. **Cadaver tendons are not recommended in young patients due to high failure rates for patients in this age group.
- Anatomical vs. Non-Anatomical – *non-anatomical was described as a “bandaid” that won’t work long term, so this may not truly be a choice if you want good long-term results.
- Physeal Sparing or Traditional – avoid drilling through the growth plates (physeal sparing) or drill directly through them (traditional)
Each doctor is most likely comfortable with one way of doing this repair and if you want another way, then you likely need a different doctor. So bone up on the pros and cons and current research for each of the above choices before you interview your surgeons. And don’t just take the first surgeon you are referred to!
Pediatric ACL Surgeon – Who’s the Best?
Massachusetts - Dr. Mininder Kocher,Boston Children’s Hospital
Tennessee - Dr. Allen Andersen
Repairing an ACL is a fairly common surgery for adults. The key part of that last sentence for adults. Pediatric ACL surgery becomes trickier and the surgeons that can adequately perform this surgery are harder to find. The reason? Those immature bones and open growth plates our kiddos have right on both sides of the knee.
Plus, I don’t want adequate. I want a brilliant, experienced, I can do this in my sleep. surgeon for my daughter.
The Denver area doctor that was recommended by both the Steadman Hawkins staff and also by Dr. McNair of Panorama Orthopedics and Spine Center is Dr. John Polousky. We are meeting with him on Wednesday and I will let you know if we decide to go with him or not.
Our other option, should we decide this is best for Jaeda, is to fly to Boston and have Dr. Kocher repair her knee using a physeal sparing technique.
The issue with the traditional ACL repair is that it involves drilling a tunnel right through the growth plates. Growth plate disruption can cause that leg to be shorter than the other if it inhibits growth of the leg. I don’t know the statistics on how likely that is to happen, but will ask tomorrow.
Alternatively, Dr. Kocher drills the tunnels required for the ACL repair in places that avoid the growth plates, thereby avoiding the issue of different length limbs. On the surface – if it has the same outcome for knee stability and the failure rate (needing another surgery in a couple of years) is the same or lower than the traditional drilling location, it seems a no brainer. But these are questions I still haven’t had answered yet and I don’t understand the mechanics of how each repair works. Hey, I’m an engineer. I want to see the mechanics. :)
I’ll let you know what we decide.
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