Surgical Information

Pediatric ACL Reconstruction

What is pediatric ACL reconstruction?

Pediatric ACL reconstruction is surgery to rebuild a torn anterior cruciate ligament (ACL) in the center of the knee.

ACL injuries are on the rise among children and adolescents. Youngsters participate in sports earlier in life and at a higher level of competition. Young athletes are also increasingly specializing in one sport, putting them at risk for overuse injuries once seen only in professional athletes.

Most pediatric ACL injuries are complete tears in which the ligament and part of the bone separate from the rest of the bone. Usually, surgery is indicated for these injuries. Conventional ACL surgery, in which the surgeon makes incisions into the bones on either side of the knee joint and replaces the torn ACL with a tendon graft, is not a good option for young patients. Working growth plates in the knee joint are still producing bone tissue. If the growth plates are damaged during surgery, the bone may not grow properly.

Surgical options for children and adolescents vary according to age and musculoskeletal maturity:

  • Physeal-sparing surgery eliminates the need to drill tunnels across the growth plate. This surgery is the preferred approach for patients up to about 13 years old.
  • Transphyseal reconstruction is closer to a traditional adult ACL surgery, but keeps the primary fixation away from the growth plate. This is the preferred approach for adolescents between the ages of 13 and 17.
  • Adolescents over the age of 17 who have finished growing are candidates for conventional ACL surgery.


The ACL is one of the four major ligaments of the knee. It runs diagonally in the middle of the knee and connects the back of the femur to the front of the tibia. The ACL helps stabilize the knee joint and keeps it from rotating.

When is surgery recommended?

Most pediatric ACL tears are complete tears that do not heal on their own. In the past, the standard recommendation was to wait until after puberty to perform ACL surgery. However, a child with a torn ACL risks further injury to the knee with everyday activities. Therefore, surgery is almost always indicated.

The type of surgery performed varies according to the patient’s age and musculoskeletal maturity. Children mature at different rates, so it’s important to consult an orthopaedic surgeon with expertise in growth-plate sparing ACL surgical techniques. A consultation with the proper surgeon can help determine the most appropriate surgical option.

What is the recovery time?

Recovery time differs by patient and the type of procedure performed. Generally, patients begin using an exercise bike immediately after surgery and start physical therapy to restore strength and range of motion two weeks later. Light jogging and running can commence three months after surgery, and most patients return to sports, often with a custom brace, six to nine months post-procedure.