1. Potera, Carol


New recommendations focus on prevention, particularly in young girls.


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Anterior cruciate ligament (ACL) tears are on the rise in young athletes, especially in girls playing soccer, basketball, lacrosse, and gymnastics and boys playing football and lacrosse. A new report from the American Academy of Pediatrics (AAP) outlines the diagnosis and treatment of ACL injuries and proven ways to prevent them.

Figure. Following AC... - Click to enlarge in new windowFigure. Following ACL surgery, high school basketball player Mia Loyd begins rehabilitation with her therapist. Photo by Richard Sennott / Star Tribune.

The ACL is one of four major ligaments that stabilize the knee joint during activity. The risk of injury to the ACL increases during adolescent growth spurts, starting at age 12 in girls and age 14 in boys. And athletes who've had an ACL injury are as much as 10 times more likely to develop degenerative knee osteoarthritis within 10 to 20 years.


Early surgery for ACL tears in teens is recommended, and the rate of successful restoration of knee stability is 90%, as is the level of postsurgery patient satisfaction. However, surgical techniques may involve drilling into the growth plate, which introduces a risk of complications such as premature closure and limb-length discrepancy.


"Newer surgical advances spare the growth plate and reduce injuries," said Michael Zychowicz, director of NP and orthopedic NP programs at the Duke University School of Nursing. To improve outcomes at Duke, children with an ACL injury and open growth plates are frequently referred to pediatric orthopedic specialists for evaluation, management, and surgical repair.


Some ACL injuries are acute and don't require immediate surgery. "They can be rehabilitated by strengthening the supporting quadriceps and hamstrings," said Zychowicz. Such exercises also reduce the risks of meniscus tears and osteoarthritis.


Physical training also reduces the risk of ACL injury, especially in female athletes. Experts at the AAP recommend plyometric exercises, like repetitive jumping, to build stronger muscles and stretching and balance training.


After such training, the greatest reduction in injury risk occurs in female athletes 14 to 17 years old, in whom the risk falls by 72%, compared with 16% in those 18 and older. Evidence-based instructional materials covering preventive exercises for use by physicians, coaches, and athletes are available at Potera




LaBella CR, et al. Pediatrics. 2014;133(5):e1437-e1450