ACL injuries increasing among youngsters

The number of children with anterior cruciate ligament (ACL) injuries is growing, largely because more kids are participating in sports, more intensive sports training is beginning at an earlier age, and because of increased awareness and greater imaging ability, according to a new clinical report from the American Academy of Pediatrics.

The report also explains that girls passing through puberty may be at particular risk. Adolescent females have 2 to 6 times as many ACL injuries as boys do in similar sports. Thus, all children, but perhaps especially girls, would benefit from neuromuscular training in early to middle adolescence when risk factors for ACL injury begin to develop.

The publication says those risk factors include higher body mass index, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of the trunk and lower extremities. The researchers say that neuromuscular control may explain the difference in noncontact ACL injury rates between boys and girls.

As for diagnosis, the report says the best physical examination test for an ACL tear is the Lachman test, but that magnetic resonance imaging can be a valuable diagnostic tool for patients with excessive pain or swelling and/or a lack of cooperation.

Because an ACL tear is not a surgical emergency, the report advises that physicians take the time to discuss with patients and parents their performance goals and expectations and various treatment options, taking into account the patient’s skeletal age and Tanner stage. They suggest advising patients and families that regardless of the chosen treatment, youngsters with ACL injuries are at increased risk of early-onset osteoarthritis.

Visit AAP’s Council on Sports Medicine and Fitness for resources on the subject of ACL injuries, 

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