Thursday, September 19, 2013

What Do You Do When Your Child Tears His ACL


I was at the supermarket yesterday when I met a patient of mine and his wife. After we exchanged greetings they informed me that their teenage child had just tore his anterior cruciate ligament (ACL) during football training at the Singapore Sports School recently. 


A MRI scan taken confirmed that the ACL was torn. In addition, to complicate matters,the MCL and meniscus was also damaged and there was some bone bruising as well. They then asked for my opinion on what he should do. 
I thought writing about our chance encounter would be really helpful for other parents too and so this is how today's post came about.
My immediate suggestions were to settle the inflammation, regain pain-free full range followed by strengthening the muscles around the knee joint before deciding whether he needs to reconstruct his ligament. All of which are covered in this post in our other blog.
Concurrently, they probably needed to consult a surgeon or two as to whether he needed surgery. In an earlier post, we discussed a published study in which active adults who opted for specialized rehabilitation  after tearing their ACL may not need the operation as their knees were found to be clinically stable and had no real loss in function even five years later. 
However, their teenage son is definitely different from the active adults studied. Evidence suggests that athletes definitely perform better with a reconstructed knee. They definitely needed to discuss at length with their surgeon and their son as well whether he wants to resume competitive sports. I suggested that their son be present at these discussions as he may need to explain his own medical history to his future coaches and subsequently when he reports for national service in the army as well.
One important consideration would be the graft the surgeon chooses to use. Some studies suggest that using the hamstring graft means the hamstring muscle remains weakened even up to five years after the operation despite rehabilitation. There are also cadaver ligaments although a number of studies show that these frozen and sterilized tissues may not be as strong as the bone patella tendon or hamstring option.
One final suggestion was for their child to remain in close touch with his team. He should attend training sessions and games still and help with the coaching staff if necessary. this ensures he feels he's still part of the team and keep his spirits up.
* Picture from richseow - Raffles vs ACJC  'A' Division semi finals match, 2013.

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