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ACL Recovery

ACL Surgery In The Growing Athlete: Save The Growth Plates

By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

• A recent scientific study showed that young growing athletes with open growth plates can successfully undergo ACL surgery with no risk to bone growth, and high success rates for return to sports
• Return to unrestricted sports took about 13 months on average in this study
• I would encourage the young athlete to consider “all inside” ACL reconstruction to avoid possible damage to the growth plates

The ACL is a main stabilizing ligament in the knee, and most athletes with a torn ACL will require surgery to rebuild (otherwise known as “reconstruct”) the ACL if their goal is to return to jumping, cutting, sprinting, and pivoting sports. Unfortunately, we are seeing more ACL tears in very young athletes. While ACL surgery in adults is a fairly straightforward procedure with a high success rate, surgery in young athletes with open growth plates poses some challenges. Recent technical advances now make it possible for the surgeon to completely avoid the growth plates.


Let’s start with some definitions. Growth plates are areas of developing cartilage tissue near the ends of long bones. The growth plate regulates and helps determine the length and shape of the mature bone. The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. When a child becomes full-grown, the growth plates harden into solid bone. The two main growth plates around the knee are in the upper tibia and lower femur. With commonly performed ACL surgery, the surgeon creates tunnels across these two main growth plates. The tunnels would then create risk of damaging the growth plates resulting in the potential for a change in length or angulation of the bone.

Over the last few years, technical advances in ACL surgery now make it possible for the surgeon to do the procedure without creating any tunnels across the open growth plates. This type of surgery is called an “all-inside ACL reconstruction”. A presentation at this week’s annual meeting of the American Orthopedic Society for Sports Medicine showed excellent results with this type of surgery. The success rate in terms of stabilizing the knee and allowing unrestricted sport activity was very high, (93%), and there were no observed changes in bone growth.

This type of ACL surgery requires specialized surgeon training, and not all sports medicine surgeons will be skilled in the procedure. But I think it would be worth finding a surgeon trained in the procedure if you are considering the surgery for your growing son or daughter.

What Would I Do With My Son Or Daughter?

We are now at the point where it makes sense to perform all-inside surgery for the young athlete with open growth plates who needs ACL surgery. The main limiting factor is that there just aren’t many surgeons trained in the procedure. You’ll have the best chance of finding a surgeon trained in all-inside ACL reconstruction in children at sports medicine clinics run through major children’s hospitals in larger urban areas. If it were my son or daughter I would research a children’s hospital sports medicine clinic in a major metropolitan area and have the all-inside procedure from an experienced surgeon. Having said that, not everyone has access to these specialized centers. We also have many, many years of solid scientific evidence that it is possible to create tunnels across the growth plates with slight modifications to the standard adult operation, with very little risk to the growth plates. You’ll find those skilled surgeons all across the U.S. With a skilled surgeon and careful attention to rehabilitation, ACL reconstruction in young athletes with open growth plates should allow a very high chance of successful sports participation and minimal risk to bone growth.

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