The decision to proceed with anterior cruciate ligament (ACL) reconstruction to treat a torn ACL on a growing child can be difficult. Parents often weigh the pros and cons of surgery versus the risks of a more conservative approach with limited activity. After surgery, they wonder how to best help their child manage the difficult recovery period and return to sports. As with many parenting challenges, there is no single right answer. Nearly 10 years after his ACL surgery, University of Michigan sophomore Gabe Kahn reflects on his story.
At the age of 9, Kahn endured a spate of leg injuries that included two broken legs, a torn ACL and a torn meniscus. ACL reconstruction and rehabilitation tested the young athlete, but nearly 10 years later, “I never think about it,” he says.
Gabe’s journey as an orthopedic frequent flier started when he broke his leg during a soccer game. After a few weeks in a cast and three months of recovery, he returned to the field, only to break his right leg a second time.
Over the next six to eight months, Gabe’s father, an orthopedic surgeon, observed ongoing weakness in the leg. An MRI confirmed a torn ACL and a torn meniscus. After consulting with an adult sports medicine doctor, the senior Kahn weighed his son’s options.
A tough decision
Conventional ACL surgery would require drilling tunnels through the growth plate (the developing cartilage near the end of long bones), but this can disrupt bone growth. However, delaying surgery posed a risk as well. With a torn ACL, Gabe’s activities would be limited, and even routine play could result in another injury.
Eventually, a third option emerged. Dr. Kahn learned that Mininder Kocher, MD, and Lyle Micheli, MD, at Boston Children’s Hospital’s Sports Medicine Division, had developed growth plate-sparing surgery and were successfully performing the procedure on growing children.
“My father told me we had to fly to Boston for Dr. Kocher to operate on me, because the risk of damaging the growth plate with a normal ACL reconstruction was too great,” says Gabe.
He approached surgery as most growing boys do: very hungry and a little nervous. Four days after surgery, the family boarded a plane for the return trip home and Gabe started physical therapy to strengthen his muscles.
The young athlete mastered his crutches and learned to walk again. However, the six-month prohibition on sports proved to be his toughest challenge.
“I was always pretty athletic and got back into soccer and football at recess as a referee,” says Gabe.
At the tender age of 10, Gabe didn’t realize it, but he was practicing good medicine. Staying involved in sports, either as a team manager or in another sideline capacity, can help minimize the psycho-social effects that follow an ACL injury, says Kocher.
Continued involvement with a sports team works in some cases, says Sharon Chirban, PhD, sports psychologist at Boston Children’s. Other kids may find it too painful to watch from the sidelines. For these kids, an alternate non-sport activity may help keep them occupied during recovery.
Martha Murray, MD, orthopedic surgeon, agrees. The individualized approach to sideline involvement is best. “Some athletes do better sitting watching their team, but many are afraid to say it is hard to do.”
The age of the athlete plays a role too. High school students are busy―trying to get to team practices and games, do physical therapy, study and prepare for college applications. “I try to explore options with each patient as an individual and see that as part of their recovery process,” says Murray.
The comeback kid
At six months, Gabe got the green light for sports participation. He celebrated by decorating his brace with blue and red flames and started playing tennis and soccer.
“Soccer had been my primary sport before the injury, but I had a hard time returning to it,” he admits. During Gabe’s recovery, his peers had continued to improve. He also worried about re-injuring his right leg. “I stopped enjoying it.”
Rather than give up on sports altogether, Gabe tried several new activities after his surgery, including tennis, basketball and football, over the next few years. Despite his orthopedic history, he succeeded. He reached the state level in tennis tournaments and made the varsity football team by his sophomore year of high school. Gabe was named captain of the football team in his senior year.
An injured athlete’s ability to transition into new sports is often a function of age, says Chirban. Younger athletes may be more likely to be frustrated by differences between their performance and their peers. They also are young enough to try new activities, and despite parents’ concerns, their identity is often not as tied to a sport as an older athlete’s. Trying a new activity can be less psychologically stressful than attempting to close the gap in performance, she says.
By age 15 or 16, older athletes with clearly established sports identities may be more willing to work to close the performance gap. But for some of these kids, a season away from the sport may put an end to their goal of participating in varsity athletics.
Chirban urges parents to remember:
- Full functionality, including healthy participation in lifelong activities, can be restored with surgery.
- Sports participation should be fun. When the fun ends for a good reason, support other activities.
Today, as a college sophomore, Gabe feeds his love of sports through intramural soccer, flag football and snowboarding.
His ACL injury is a distant memory. “It was a tough process at the time, but there’s no pain or any other issue that limits my activity. The last 10 years of my life have revolved around sports. I don’t think that would have been possible if I hadn’t had the ACL surgery.”