My 11 year old daughter tore her ACL in a soccer tournament on Memorial Day. I’ve been researching pediatric sports medicine doctors and ACL repair techniques like crazy. As any parent does these days, I hit the internet hard and fast to learn all I could about ACL surgery, pediatric sports medicine doctors and orthopedic specialists.
What did we do before all this information was at our finger tips like this?
Since the last post, we’ve had a few things happen:
- Dr. Polousky ordered an xray of Jaeda’s left hand to determine her bone age. It came back that her bone age is 13 vs. physical age of 11.5. This means her bone development is the same as the average 13 year old girl THIS IS IMPORTANT.
- Dr. Polousky also got a few xrays of her spine (she has a 12 deg lumbar curvature we’re tracking) and pre-op pics of her legs to see if they are even and straight pre-surgery for comparison to post surgery.
- I mailed a disc of Jaeda’s MRI and initial xray to Boston for Dr. Kocher to review. Turns out they want all the reports and office visit notes too, not just images, so I sent a second disc with her latest images and all the reports a couple of weeks ago. Getting those from Children’s Hospital Denver was a royal pain in the ass (different post).
So here are the big questions that
we I was asking both doctors to answer:
- Are Jaeda’s growth plates closed enough to have the modified adult ACL repair (which drills tunnels through the growth plates)?
- Are her growth plates open enough that she should have the physeal sparing surgery perfected by Dr. Kocher?
- Why wouldn’t we just do the physeal sparing ACL repair regardless of this borderline growth plate issue?
- When are you available to do the surgery?
A doctor from Boston called me after he reviewed the first images I sent and said:
- He recommended the physeal sparing ACL repair because the knee images looked like her growth plates were wide open.
- Dr. Kocher was booked at least 2 months out and there wasn’t any way he’d get her in before school started.
- We’d need to be in Boston for a week and most of that would be in a hotel not the hospital.
I asked the doctor (resident?) if it made a difference on his recommendation that her bone age was 13. He said “Yes, that does make a difference.”
He hadn’t received that report yet and hadn’t had it to look at prior to calling me. He said that Dr. Kocher recommends the modified adult ACL repair for girls over the age of 12 (for boys it’s 14), so that if her bone age said 13, it would make a difference. He wanted to see that report and discuss it with Kocher and would call me back.
My next question:
Is there a better outcome with the modified adult than the physeal sparing?
No, it seems to be about the same.
Why wouldn’t we go with physeal sparing regardless then?
The modified adult is more consistent with the path of the natural ACL. They haven’t seen any difference in “failure” rate or function between it and the physeal sparing technique, but it seems like it should be better because it’s closer to natural. The physeal sparing puts grooves in the top of the bone to keep the tendon in place so theoretically the tendon could slip out of the groove vs. the tunnels where that isn’t possible. Also the physeal sparing uses the IT band for the replacement tendon and the modified adult uses the hamstring. They need their IT band.
Doesn’t she need her hamstring too?
There are 4 hamstrings and the hamstring grows back kinda. They aren’t quite sure what the substance is that forms to replace the hamstring, but it functions the same and the strength difference between the leg with the missing hamstring and the other leg is negligible ~ 2 to 3% if any.
Yesterday Jaeda and I met with Dr. Polousky to see what he thought after seeing the additional xrays.
Stay tuned for our decision…