ACL reconstruction in 14 year old

[marco1]

Hi All - hope someone can give me some advice here. My son ruptured his ACl just over 2 years ago and had some surgery to remove what was left of the ligament and then some physio. He has done pretty well and managed to play cricket and badminton with a knee brace. However, he is now 14 and I believe the time has come to have a reconstruction as he wants to do more walking for Duke of Edinburgh and he finds it diffucult walking down hill - it starts to hurt quite quickly. Also from what I have read it would seem to be best not to leave it too long.

The surgeon we are seeing has done many of these but I have no real idea of how good he is although he does all the footballers up here in the north east so I am assuming he is good.

Some questions - who is the best for ACl reconstruction in the UK? What can we expect in terms of sporting activity from this operation; wil my son be able to snowboard again (maybe with a low profile brace). Hope you understand my concern as I would hate to do something that might make things worse. Any help or advice would be much appreciated.

Cheers,

Mark.

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[physiobob]

The first thing is that you can expect that he will be able to snowboard following a reconstruction. I would avoid the patella tendon graft option as this can leave you with potential patella tendon issues in a growing child. The operation is only part of the rehabilitation. Without an ACL the brain lacks some feedback/feed forward information on what is happening at the joint. The joint is also lacking some of it's rotational stability and normal functional movement. A firm (as opposed to slack) graft is important in the first instance. Then a large amount of proprioceptive retaining is required to maximize the function in the leg. The more of that your son does, perhaps the better the outcome.

As one surgeon said to me once..."You can have great surgery with poor rehab and have a poor result, you can have poor surgery and poor rehab and have a poor results BUT you can have poor surgery but great rehab and gain a good result"... It was anecdotal but the message is clear that the rehab is more important than the surgery.

[marco1]

Hi Physiobob - thanks for your reply and helpful advice - its very much appreciated. What does 'proprioceptive retaining' mean?

Thanks,

Mark.

[radhika28071985]

Hi Mark !!
read through your post .. It is quite natural to have concern towards ones childs operation .. but trust me , it is nothing big to worry about ..
ACL reconstruction is nothing big these days.. You can get it do0ne from some nice Ortho Surgeon in the UK .. What is most important is that your son needs to go through a complete Physio rehab systematically ... If given the perfect rehab ,he would for sure be able to carry on with most of his sports .. nothing would be an obstacle..
BUT PHYSIO IS MOST IMPORTANT... PLs do not ignore .. get him to the best Physio ,most of strengthening and Pliometric training would be good ..
All the best,
Radhika