The ACL lies in the middle of the knee and provides rotational stability to the knee. It prevents the shinbone (tibia) from sliding forward beneath the thighbone (femur). The ACL frequently is injured with forced twisting or hyperextension of the knee during sports like soccer and basketball, where there is sudden stopping and twisting at the knee.

Since children’s bones are still growing, their bones and joints are very different from those of adults, which can complicate caring for ACL injuries in children. Parents should talk with a pediatric orthopedic surgeon about their child’s injury to find the best way to make sure their child has a knee that functions normally and does not hurt.

Nearly all ACL injuries in children first are treated with a course of supervised physical therapy and rehabilitation sessions to strengthen the hamstring and quadriceps muscles. This initial phase of treatment provides parents the chance to learn more about the various options for ACL surgery for their child.

• Non-surgical treatment only, such as physical therapy to regain strength in the knee and bracing when the child engages in sporting activities.
• Surgery to reconstruct the ACL and to repair other injuries that occurred at the same time, such as a meniscus tear. Most ACL surgeries involve inserting instruments through small incisions in the knee (arthroscopic surgery). Open surgery (cutting a larger incision in the knee) sometimes is required. Physical rehabilitation always follows surgery.