Considerations for Adolescent ACL Reconstructions

Adolescent and young adult ACL reconstructions are a common diagnosis among my caseload.  I often get the opportunity to consult and or provide pre-operative physical therapy in many of these cases.  Nearly all of my ACL patients participate in athletics, so it’s imperative to return them to a high functional level.  Complete rehabilitation requires 9-12 months of focused therapy and dedicated hard work by the patient, but it’s also important to get off to a good start.  Difficult decisions need to be made regarding the selection of the right surgeon, graft choice and post-op pain control.  A few recent studies have focused on the graft choice and post-op pain control in active adolescents,18 and younger, to shed light on how to achieve optimal post-op results and allow for safe and satisfying return to sports participation.

The American Journal of Sports Medicine ajsmpublished a comparison of Allograft vs Autograft in active adolescents and found that Autograft surgeries had a 11% (4/35) failure rate compared to a 29% (11/38) failure rate in Allograft surgeries.  Although the ‘n’ is fairly small in this cohort the results are in agreement with previous studies comparing Allograft and Autograft options. (See “Choosing an ACL Graft”)

The AJSM also released a paper focusing on femoral nerve blocks (FNB) as a post-op analgesic in adolescent ACL reconstructions.  Femoral nerve blocks for post-op ACLR pain control have become more prevalent recently in the adolescent population.  The benefits are decreased reliance on heavy pain medication and subsequent adverse reactions or addiction.  The disadvantages are difficulty initiating adequate quad activation and prolonged weakness due to the innervation quadriceps by the femoral nerve.  The study examined the effect of FNB at 6 months post-op by measuring isokinetic quad strength and traditional functional return to sport testing. The study found that a significantly lower percentage of patients from the FNB group (67% vs 90%) met the return to sport criteria.

Clinically I have seen empirical evidence of both studies and advise my pre-op patients to know the pros and cons involved with their graft choices and to be aware of the possible adverse effects of femoral nerve blocks.

For more ACL info check out these resources:

Howard J. Luks, MD,  Julie Eibensteiner PT, DPT, CSCS,  Chris Koutures, MD,  Steve Kennelly, ATC   

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