When a child or teenager tears an ACL or dislocates a shoulder, the stakes are higher — the growth plates are still open, the sport identity is real and the decisions require specialist expertise.
PATIENT STORY
“She is thirteen, plays competitive soccer year-round and now she has a torn ACL. I do not even know where to start. Someone told me she should wait until she stops growing. Someone else said surgery now is the only option. How do I know what is right?”
*Composite patient story. No identifying information used.
Some of the most important conversations I have in my clinic are with parents. When a 12, 14 or 16-year-old sits across from me after a significant shoulder or knee injury, there is a family navigating something frightening and unfamiliar, and they deserve honest, expert guidance that acknowledges both the medical complexity and the human reality of youth sports injury.
youth sports injuries occur annually in the United States
are attributed to overuse from single-sport specialization
increase in pediatric ACL reconstruction over the past 20 years
of youth sports dropouts cite injury as a contributing factor
The Growth Plate: The Factor That Changes Everything
In a skeletally immature athlete — one whose growth plates (physes) have not yet closed — standard adult surgical techniques for ACL and shoulder reconstruction carry the risk of growth disturbance if the growth plate is damaged during surgery. Growth disturbances can cause leg length discrepancy or angular deformity.
This does not mean surgery should be avoided. It means surgery must be performed by a surgeon who understands physeal anatomy and uses growth-plate-sparing or physeal-respecting techniques specifically designed for skeletally immature patients. In the right hands, these techniques have excellent outcomes and do not compromise growth. Skeletal maturity is assessed through a combination of age, clinical assessment and bone age, regardless of chronological age.
Pediatric ACL Tears: The Evolving Standard of Care
A decade ago, many surgeons recommended waiting for skeletal maturity before performing reconstruction — leaving young athletes with an unstable knee for months or years. That approach has been largely abandoned in current practice, and for good reason. Research has consistently shown that non-operative management of complete ACL tears in active young athletes leads to high rates of subsequent meniscus and cartilage damage from repeated instability episodes. Protecting those structures by stabilizing the knee — using physeal-appropriate techniques — is now the recommended approach for most active skeletally immature athletes with complete ACL tears.
GROWTH PLATE SPARING ACL TECHNIQUES: WHAT THEY MEAN
Physeal-sparing or physeal-respecting ACL reconstruction uses tunnel positions and graft configurations that either avoid the growth plate entirely or cross it at the correct angle and size to minimize growth disturbance risk. The specific technique depends on the degree of skeletal maturity. A nearly-mature teenager may be treated very similarly to an adult; a 10 or 11 year old requires a fundamentally different approach. This is precisely why choosing a surgeon with specific pediatric sports medicine expertise is not optional — it is essential.
Shoulder Instability and Dislocation in Young Athletes
The recurrence rate for shoulder dislocation in young athletes treated non-surgically is strikingly high, some studies report rates of 80 to 90 percent in athletes under 20. Each recurrence damages the shoulder more, eroding labral tissue and bone from the glenoid, or socket rim. This creates a compelling argument for early surgical stabilization in young, active patients with confirmed labral tears after a traumatic dislocation.
The arthroscopic Bankart repair with or without remplissage, described in earlier articles is generally performed the same way in teenagers as in adults, with excellent reported outcomes. The primary considerations are timing, confirming the diagnosis with appropriate imaging and having an honest conversation with the athlete and family about return-to-sport expectations and the rehabilitation commitment required.
Overuse Injuries in Young Athletes: When Surgery Is Not the Answer
Not every injury in a young athlete is traumatic. Overuse injuries, including but not limited to, stress reactions, apophysitis, patellar tendinopathy and shoulder impingement from excessive overhead volume — are increasingly common and are almost always treated without surgery. The key interventions are load management, physical therapy to look at imbalances and dysfunction of surrounding soft tissue, cross-training and an direct conversation about sport specialization.
A WORD ON EARLY SPORT SPECIALIZATION
The research on early single-sport specialization is sobering. Young athletes who specialize in a single sport before age 12 have higher injury rates, higher burnout rates and, paradoxically, are not more likely to achieve elite status than multi-sport athletes. This is not an argument against competitive youth sports. It is an argument for balance, variety and listening to your child's body and love of the game above all else.
A Direct Message to Parents
Get your young athlete evaluated by an orthopaedic specialist who has specific experience with pediatric and adolescent athletes. A general emergency room visit is appropriate for acute injuries, but follow-up care should be with a specialist.
Do not let your child play through significant pain. Acute or chronic pain alters mechanics leads to compensatory patterns that create secondary injuries.
Involve your child in the treatment decision. A 14-year-old who understands their injury, their options and their rehabilitation has dramatically better compliance and outcomes than one who is just told what to do. I explain everything directly to my young patients. Their understanding and buy-in are part of the treatment.
The Goal: A Lifetime of Movement
When I treat a young athlete, I am not just thinking about getting them back for the next season. I am thinking about the shoulder and knee they will have at 20, 30, 50 and 70. Sports teach children courage, resilience, teamwork and the relationship between effort and reward. Those lessons are worth protecting. A well-treated injury, managed with expertise and patience, does not have to end a young athlete's relationship with sport.
Young athlete with a shoulder or knee injury?
Dr. Jamie Lynch sees pediatric and adolescent athletes at TruOrtho and understands the unique surgical and non-surgical needs of still-growing patients. San Antonio.
Book an Appointment: www.sportssurgeryspecialist.com |
REFERENCES
- Fabricant PD, Jones KJ, Delos D, et al. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete. Journal of Bone and Joint Surgery (Am). 2013;95(5):e28.
- Lawrence JT, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear. American Journal of Sports Medicine. 2011;39(12):2582-2587.
- Jayanthi NA, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes. Sports Health. 2013;5(3):251-257.
- DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports. British Journal of Sports Medicine. 2014;48(4):287-288.
This blog is for educational purposes for personalized medical advice you must see me or another qualified physician for diagnosis and treatment of any medical condition. | Dr. Jamie Lynch, M.D. | TruOrtho, San Antonio, TX | www.tru-ortho.com | www.sportssurgeryspecialist.com
