Can the ACL Be Repaired Safely in Children?

Surgeons tell me their ACL repairs are coming in younger and younger packages. 200-400,000 repairs per year (depending on who you ask) costing us multiple billions of dollars. But if you have been the parent of one of these kids you know that doesn’t even touch the cost. The pain you feel for them and what they have to endure is nearly insurmountable.

Standing by with ice, pain meds and a whole lot of support.

So I was a bit of a cynic when I attended Dr. Lyle Micheli’s talk entitled: ACL Injuries in Children, Where are We? I was thinking why are we putting kids through this? I had a lot to learn. Dr. Micheli had been introduced to ACL repair in children because of an adorable 3 year old towheaded boy who was “ACL deficient.” That is, the kid didn’t tear it, his knee just didn’t have one. So, Michaeli asked: Do you repair or do you brace it and wait until the growth plates fuse?

The problem of growing bones and their growth plates is a difficult one. Most ortho docs were waiting until the growth plates fused before repairing. Micheli found, unfortunately, that ACL deficient knees and kids (even if not playing sports) was not a good mix. They tore up their meniscii (the cushiony cartilage in their knees) in regular kid-like activities. Boys and girls equally, interestingly enough. So, Micheli asked: How can we repair but preserve the growth plate?

Micheli developed a surgery which wraps the iliotibial band (the science here) in an extra-articular (wrapping up and around as far as I can tell) fashion, guiding through a grove he creates in the front of the tibia to keep it as anatomically accurate as possible (essential for proper function). He has been doing this since 1999 with great success.

But let’s not stop there. Here is the new direction they are investigating. Dr. Martha Murray has developed repair-growth factors that she can inject into the knee. They are teaming up. Micheli is trimming away the ACL and Dr. Murray’s biogenic growth factors are stimulating the ACL to repair itself. (read about it here.) Now if that isn’t amazing, I don’t know what is. It even takes care of the “how long do you wait?” question. You wait until mother nature restores your knee to working order.

One other thing about Dr. Micheli…he has been the medical director of the Boston Marathon for many, many years. Yes, he showed us photos and told us stories about busting down barriers, wrapping tourniquets, and whisking people from finish line to OR in 60 minutes. The pride he felt for his team that day may rival everything else he’s done.

Even the fact that apparently the blond-headed 3 year old whose ACL was his first pediatric repair now helicopter-skies with no knee problems.

Next up: Training the Fittest, A little pain along with the gain

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