ACL Injuries in Children: Diagnosis and Treatment Options

As a parent, it’s normal for your child to experience bumps and bruises while actively participating in sports like football. However, it can be difficult to determine when an injury is minor or potentially serious. 

One such injury that can occur is an Anterior Cruciate Ligament (ACL) tear, which is a key ligament in the knee that provides stability during activities such as running, walking, and jumping. Children are especially prone to ACL injuries due to the excessive pressure they put on their knee joints.

If your child has damaged their ligament, it can significantly impact their participation in physical activities. Therefore, following an effective treatment plan to address the injury and restore optimal knee joint function is essential.

Scroll down to learn more about the causes, treatment and diagnosis for ACL injury and much more to achieve the best possible recovery.

Causes of ACL injuries in Children

The anterior cruciate ligaments are a strong band of tissue that connects the ends of the femur and the front of the tibia. They often sustain injuries due to sudden jerks and jolts.

The anterior cruciate ligament (ACL) restricts the tibia bone from moving forward concerning the femur bone and prevents excessive knee joint rotation during dynamic sports movements involving twisting and landing. Here are the primary causes of ACL injuries in children.

  • Sports-Related Injuries

Several studies reveal that young athletes engaging in sports like football, basketball and soccer are more prone to ACL injury. For instance, abrupt changes in motion, such as sudden stops or decelerations during running or jumping, as well as improper landing techniques, can put significant stress on the ACL and increase the risk of tearing this cruciate ligament.

  • Non-Sports-Related Injuries

In contrast, sudden impact due to acute trauma from external factors to your child’s knee can result in ligament stretch and tear.

Symptoms of ACL Injuries in Children

When young individuals experience ACL injuries, they might hear a sudden popping noise or feel knee joint instability. Here are a few common signs of ACL injuries in children

  • Pain and Swelling in the Knee

The knee appears swollen in the first few hours or days after the injury. The swelling also induces pain that worsens with the return to sports or other activities. The knee feels unstable, which increases the risk of the meniscus (cushioning cartilage in the knees). 

  • Limited Range of Motion

Young athletes often experience fatigue and stress in their knees, which hinders their ability to move freely. It is attributed to ligament and cartilage damage, ultimately limiting their range of motion.

  • Difficulty Walking or Bearing Weight on the Affected Leg

When children get injured, they may develop inflammation or swelling in their knees, which can reduce. However, even if the injury results in a torn anterior cruciate ligament (ACL), the child may still be able to walk.

Diagnosis of ACL Injuries in Children

If children are susceptible to ACL injuries, the doctor examines the keen joints and may instruct specific tests to locate the injured ligaments. Below are the methods for ACL injury diagnosis.

  • Physical Examination

The healthcare professional will discuss the child’s medical history and symptoms with you. After that, they will perform a complete physical examination of the injured area to detect the exact cause of the condition. 

  • Imaging Tests 

As a part of the ACL diagnosis, your physician might use an X-ray and an MRI scan to confirm the injury.

Treatment Options for ACL Injuries in Children

  • Non-Surgical Treatments

Regarding children, physicians often opt for ACL treatment without surgery to avoid further damage to their fragile bones. The approach is designed based on the age and severity of the tear in the patient. Usually, REST therapy is suggested for better results.

  1. Rest – Opt for rest and avoid activities that will extend the damage level of the ligament.
  2. Ice – Apply ice packs to the injured knee daily.
  3. Compression – Compress the injured knee with a wrap or bandage
  4. Elevate – While laying down, prop your knee above the level of your heart
  • Medications

NSAIDs (Non-steroidal anti-inflammatory) drugs like ibuprofen are generally prescribed to decrease swelling and prompt healing.

  • Surgical Options 

When the injury or pain is not resolved through non-invasive treatment options, ACL reconstruction surgery is usually recommended to ensure the long-term preservation of the affected knee. It drives young patients to return to their sports or daily activities early.

The process involves creating a new ACL from the tendon to recover from the injury and raging the range of motion and strength. The success rate of surgery is around 90% based on the patient’s satisfaction with restoring knee stability. New surgical procedures are still being developed that will not disrupt the growth plate in children and could be safely performed. 

Complications and Risks

Despite the best treatment, children might experience certain potential complications with injury or surgery. The most common complications are listed below:

  • Infection

Several studies indicate that the risk of infection from ACL injuries is relatively low in children. Simple or mild infections are resolved with antibiotics, while severe ones require surgery and intravenous antibiotics.

  • Graft Failure

Using allograft techniques to treat ACL injuries might fail some individuals, leading to the reoccurrence of the condition. The risk is higher when the child’s hamstrings are implemented.

  • Knee Stiffness and Weakness

Stiffness and weakness is a common complication when more than one ligament or cartilage is damaged. In most cases, the condition will be improved with effective physical therapy and exercise. 


The effects of ACL injury in children can be long-lasting. They might even develop early osteoarthritis when they don’t receive proper treatment for ACL injury. Therefore it is extremely important to opt for early diagnosis and treatment so your child can rebuild strength and stability and enhance their confidence in using their injured knee.

Doing more than treating their current ACL injury is important to help your athletic child play safely. Hence, teaching them to maintain muscle balance and good body mechanics will reduce the risk of injury and promote their sports performance.

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