Should a child return to sports after an ACL injury?

Today's guest blogger is Robert Marx, MD, an orthopedic surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery in New York City.

One of the most common knee injuries in young people is a torn ligament, particularly the anterior cruciate ligament (ACL). Young athletes, especially those in their adolescence, are more likely to sustain ACL injuries as well as those who participate in cutting and pivoting sports such basketball, soccer, football, skiing and lacrosse.

The rate of ACL reconstructions in New York per 100,000 population aged 3-20 increased from 17.6 cases in 1990 to 50.9 in 2009, according to a recent study. Patients aged 15-18 had the highest rate of ACL reconstruction and also the greatest increase in the number of reconstructions in the 20-year span.

I've seen in my own practice the increase of injuries in young athletes, especially as the pressure to excel in one sport and to get recruited increases for them. ACL tears in children and teens can lead to longer-term injuries, such as arthritis, so it's important to know how to prevent these tears and the proper way to fully recover.

Here are a few recommendations on what parents and children should do to avoid greater injury down the road.

Enroll in prevention programs early. The best way to lessen the risk of ACL surgery is to perform certain exercises to increase strength and balance and practice proper landing techniques. You can do these at home or as part of your physician's recommended prevention programs. The other option is to stop playing cutting and pivoting sports and substituting them for other athletic activities in which the risk of ACL injury is low—such as swimming, cycling, golf, baseball and ice hockey.

Participate in more than one sport. Children who participate in multiple sports instead of specializing in one sport can speed up overall muscle development and decrease the risk of injuring a focused part of the body. The knee is especially prone to injury when an athlete focuses on participating in a contact sport or in a sport where the knee is left vulnerable like in tennis, gymnastics, volleyball and handball.

Discuss with your physician whether surgery is necessary. Many people, especially younger active patients or athletes seeking to return to a sport, opt for surgery to repair the torn ligament. About 100,000 ACL reconstructions are performed in the United States each year, and overall it is a highly successful operation. Innovative surgical techniques allow us to more precisely reproduce the anatomy and function of the original ACL. Discuss with your physician if surgery is the right step for your athlete.

Avoid returning to a sport too soon. After a primary ACL reconstruction, patients must avoid a hasty return to sports to avoid the need for revision surgery or further tears.  The recovery period for each child is different, so patients are advised to seek out a specialist with ample experience in ACL surgery for the best chance of a good outcome.

Marx recently spoke at the 16th Annual Sports Medicine for the Young Athlete symposium in New York City, at a panel titled "Return To Play After ACL Injuries - Should a Child Retire or Return to Contact Sports After ACL Injury?"  Marx is also the author of "ACL Solution; Prevention and Recovery for Sports Most Devastating Knee Injury" and "Revision ACL Reconstruction; Indications and Technique."

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