Child ligament repair

Adrian and his team have unique experience in children’s knee problems, having introduced new procedures for treating anterior cruciate ligament (ACL) injuries.

The ligament repair procedure which Adrian and his team have pioneered is much less invasive for the younger patient than ligament reconstruction as it allows them to keep as much of their own tissue as possible. This facilitates quicker healing and means they can return to activities and sports much quicker, typically around 14 weeks.

Why ligament repair?

Traditionally, ligament injuries in children have been reconstructed using a graft of their own or their parent’s hamstring. There has been an understandable reluctance in the orthopaedic community to undertake such an extensive operation on the developing knee of a child.

The return to activity and sport can take as long as 10-12 months following traditional reconstructive surgery. For young sportsmen and women, who may already be playing sport at an elite level when their injury occurs, this has potential life or career-changing impact.

Adrian’s group have recently reported on these techniques in the European knee journal, ‘Knee Surgery Sports Traumatology and Arthroscopy’ and presented at both national and international orthopaedic meetings including the British Association for Surgery of the Knee and European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).

Notably, in the 2-year follow-up data gathered by Adrian’s group, none of their patients have suffered any complications of growth disturbance, neither have they experienced a single failure of the ligament repair technique.

Anterior cruciate ligament (ACL) repair surgery in children

Adrian has particular expertise in carrying out ACL repair in children. Traditional ACL surgery meant a recovery time of up to a year. However, new procedures for treating ACL injuries have reduced this to around four months.

If an adult is injured and damages their anterior cruciate ligament, the tear (rupture) usually occurs in the upper or middle part of the ligament. However, in children and young people, the attachment of the ligament to the bone is a weak point and the ligament can be completely separated from the bone, possibly with a fragment of bone still attached.

In some cases, it may be possible to re-attach the bone fragment along with the ligament using keyhole surgery. However, ligament re-attachment can only be carried out in the first few weeks after an injury. In some cases, Adrian may also advise carrying out the All-Inside reconstruction technique and anterolateral ligament (ALL) reconstruction alongside ACL surgery to improve the outcome.

How long is the recovery?

After surgery, your child will need to walk with the assistance of crutches initially, limit physical activity and wear a full-leg brace for 4 to 6 weeks. Painkillers and anti-inflammatories are prescribed initially to ensure they remain pain free.

Recovery from ACL surgery can take as little as 4 months using the more innovative techniques which Adrian uses. Physiotherapy is a big part of this to restore the range of motion, regain strength and stability and reduce swelling.

Can children return to sport after injury?

Getting back to sport is a definite possibility. Professor Wilson operated on an 18 year old elite Lacrosse player who was back on the pitch within 4 months.

More usually, we recommend children get back to more gentle activity such as swimming, cycling before progressing to running. Contact sports may remain off limits for a number of years, however we always review patients regularly and advise on activities which can be safely enjoyed.

Anterior cruciate ligament (ACL) reconstruction in children using a parent’s hamstring as a donor graft

Adrian saw this procedure, pioneered by Dr Leo Pinczewski in Sydney, Australia, and its exceptional results during his fellowship. When he returned to the UK, he decided to set up a service to provide this innovative technique.

While hamstrings grow in length, they don’t thicken and can remain very thin, especially in small children. However, using a parent’s hamstring to repair an ACL injury has been shown to reduce the failure rate from 30% to less than 10%. During the six years that Adrian has been carrying out this procedure on children, surgery has been 100% successful.


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    What Adrian's patients say:

    Karen Langridge, Rowan Dennett’s mother.

    “Professor Adrian Wilson may recall operating on my son, Rowan Dennett in August 2016.

    Rowan is now studying ACL injuries in science at high school and is taking his video of the surgery into school.

    This prompted me to email and say that Rowan has successfully returned to swimming last autumn and ball sports in December and is now back to playing tennis (county level) and cricket competitively and is also just starting his training for gold level life saving award with the Royal Life Saving Society. It’s now impossible to tell that he ever injured his knee.”

    September 2017


    A small selection of case studies