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Teen ACL tears
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Teen ACL tears - July 20, 2005 6:32:00 AM
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treybien
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Joined: August 5, 2002
From: Milwaukee, WI
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I am new to the private ortho practice arena after 5 years of Work Comp only ortho. I have a 15 year old male with an isolated ACL tear. What is the medical management in this case? Is he too young for for surgical graft because of growth plates? In your experience is bracing and rehab going to allow him to play hoops and/or football? Any strong biases on brace brand? Thanks, Ryan
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Re: Teen ACL tears - July 20, 2005 7:02:00 AM
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KAK
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Ryan,
I don’t see a lot of these kids in the clinic, but I have one at home. She had an ACL reconstruction at age 15 and is doing great almost a year later-at soccer camp at this moment.
Management depends on the stage. If acute, you want to address the swelling and ROM issues. Then, begin strengthening and proprioceptive activities. Do not neglect the hamstrings because, in theory, their posterior position on the tibia helps limit the anterior translation. Pay close attention to the joint’s response- increased swelling and pain means you need to back off.
If this young man is active, I believe ACL reconstruction is warranted. There is not necessarily a rush for this as most surgeons won’t do a repair immediately after injury because the initial inflammation/ROM restrictions can lead to complications. Basically, the surgery would add more trauma before the tissue can recover from the trauma of the injury.
I know there are some “copers” who do well without surgery, but I think they are a minority. The instability left after an ACL tear leaves the joint vulnerable to meniscus injury. My opinion is that a functional ACL brace won’t really provide enough stability to protect the joint.
I’m sure some of our sports medicine therapists can shed more light on this for you.
Kathy
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Re: Teen ACL tears - July 20, 2005 6:37:00 PM
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Synergy
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From: Texas
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I agree with Kathy on most points, especially in regards to rushing into surgery. Having an ACL reconstruction too soon after the injury may set this kiddo up for a cyclops lesion and potentially other complications as well. Some doctors have stated that the surgery is best performed 3-8 weeks after the incident.
While Kathy made a point regarding the potential ineffectiveness of a brace, at least wearing one will provide some stability that he would not have otherwise, and it may help to prevent any meniscal injury from occuring.
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Chris Adams, PT, MPT
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Re: Teen ACL tears - July 21, 2005 3:49:00 AM
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treybien
Posts: 85
Joined: August 5, 2002
From: Milwaukee, WI
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I have rehabed many an ACL, operative and non-operative, just never a young athlete. He saw the MD and they want to wait at least a year because of possible surgical disruption of the growth plates. So now I guess we rehab him based on symptoms on a functional progression. We will see if the knee allows him to do what he needs to do to be able to play, most certainly in a brace. Thanks for the other info PT's. Ryan
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Re: Teen ACL tears - July 21, 2005 4:30:00 AM
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KAK
Posts: 200
Joined: December 1, 2004
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Ryan,
I didn’t realize that a surgeon had already made the decision to hold off on surgery. Of course a brace is better than nothing. My thinking was that unless the patient was a coper, choosing a brace vs. surgery wasn’t in the best interest of the joint’s long term health.
http://www.physsportsmed.com/issues/1999/10_01_99/paluska.htm
This looked like it had some interesting brace comparison info. It's a little old, but could provide a place to start.
I hope he does well!
Kathy
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Re: Teen ACL tears - July 21, 2005 11:31:00 AM
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aquatherapysc
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Waiting a year for surgery seems appropriate given the age of the patient. Also, as depressing as it may be for the patient, he should not be playing competitive sports until after the surgery. Both football and basketball require quick bursts of speed accompanied with sharp cutting, not good for someone with an ACL injury. He can hone his shooting and passing skills and hit the gym to build up his upper body until he has the surgery.
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Re: Teen ACL tears - July 21, 2005 4:17:00 PM
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jma
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From: NY
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It makes sense to wait a while, even if it means missing high competitive sports. Many will have their take on this but this this is my opinion.
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Re: Teen ACL tears - July 22, 2005 4:02:00 AM
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JLS_PT_OCS
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If there is an isolated ACL injury and the MRI does not demonstrate any other joint injuries such as significant meniscal or chondral lesions, then holding off is perfectly acceptable.
The patient needs progressive rehab and perturbation training as well, which I'm sure you are already doing.
I am sure the brace companies would like you to think that one is better than the other, but I doubt much real data exists on this. I think any reasonably priced item advertised as an "ACL Sports Brace" would work nicely.
What sport is the patient playing/wanting to play?
I would be wary of high impact/twisting/pivoting stuff like soccer, basketball, etc. Get some good sport specific rehab in first. But if this is a cross country runner, then that changes the game considerably.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Teen ACL tears - July 26, 2005 8:19:00 AM
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treybien
Posts: 85
Joined: August 5, 2002
From: Milwaukee, WI
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unfortuneately he is a football and basketball player. The original orthopod said "do what you can" the pediatric orthopod said "check with your therapist first". We will get him in a brace and rehab him up the progression of strength, perturbation/balance, functional strength, agility and see what he can handle. Frankly I am not optimistic about return to football or basketball but we will see how he rehabs. Thanks for all the input, Ryan
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