Paediatric ACL Injuries: Prevention, Diagnosis & Physiotherapy Management
- Folarin Babatunde PT PhD
- Nov 22, 2024
- 5 min read
Cogent Rehab Blog
Folarin Babatunde PT PhD MScSEM MScPT BScPT
November 22, 2024
Introduction
The rise in youth sports participation, early specialization, and year-round training has led to a growing number of anterior cruciate ligament (ACL) injuries in children and adolescents. Because their skeletons are still developing, ACL tears in young athletes can have long-term consequences, including a higher risk of meniscal injuries and early-onset osteoarthritis. Without proper prevention and management, these injuries can significantly affect both athletic performance and quality of life.
One of the most effective strategies is the FIFA 11+ for Kids program, which has been proven to reduce lower-limb injuries in youth athletes. Below are clinical tips and evidence-based insights for prevention, diagnosis, and treatment of paediatric ACL injuries that every coach and parent responsible for children playing football.
If you’d like to learn more about how our team at Cogent Rehab supports young athletes, visit our Sports Physiotherapy services in Burlington
Prevention of ACL Injuries in Children
Clinical Tip 1 – FIFA 11+ for Kids
The well-established FIFA 11+ injury prevention program has been adapted for children by adding falling techniques and playful, partner-based exercises. This makes it more engaging while still being effective. Evidence shows that injury prevention programs like FIFA 11+ can reduce football-related lower limb injuries by 39–50%.
Our physiotherapists integrate these evidence-based approaches as part of our Injury Prevention Programs in Burlington, helping children stay active and safe.
Diagnosis of ACL Injuries in Children
Clinicians must combine a thorough history, physical examination, and imaging to make an accurate diagnosis. Unfortunately, children present unique challenges compared to adults due to skeletal immaturity and variability in symptoms reported.
Clinical Tip 2 – Haemarthrosis
Rapid swelling in the knee (within 24 hours) after injury strongly suggests structural damage.
Our clinic offers specialized Knee Physiotherapy in Burlington to assess, diagnose, and guide treatment for these types of injuries.
Clinical Tip 3 – Diagnostic Challenges
Diagnosing knee injuries in children is more challenging compared to adults because children may be poor historians, naturally have more joint laxity, and imaging interpretation is more difficult.
We understand these unique challenges and provide tailored Pediatric Physiotherapy services in Burlington to ensure children get the best care possible.
Clinical Tip 4 – Unique Injuries in Children
Skeletally immature athletes may present with injuries not typically seen in adults, such as sleeve fractures of the patella or epiphysiolysis.
Rehabilitation and Management
Both high-quality rehabilitation with a physiotherapist skilled in paediatric orthopaedics and ACL reconstruction surgery may be reasonable treatment options depending on the case.
Clinical Tip 5 – Phased Rehabilitation and Return to Sport
Rehabilitation is typically organized into four phases:
Prehabilitation (before surgery or conservative management):
Full active extension and ≥120° flexion
Minimal swelling
Ability to hold terminal knee extension in single-leg stance
Adolescents: ≥90% limb symmetry on muscle strength tests
Phase I → Phase II:
Full extension and ≥120° flexion
Minimal swelling
Single-leg stance with terminal knee extension
Phase II → Phase III:
Full range of motion
≥80% limb symmetry on single-leg hop tests with good landing strategy
Jogging for 10 min without swelling
Adolescents: ≥80% muscle strength symmetry
Phase III → Phase IV (Return to Sport):
≥90% symmetry on single-leg hop tests
Sport-specific training without pain or swelling
Confidence in knee function and movement quality
Adolescents: ≥90% muscle strength symmetry
Note: Strength testing should ideally be done with isokinetic or handheld dynamometry. If only handheld testing is available, increase cut-off thresholds by 10%.
Return To Sport Restrictions after ACL Reconstruction Surgery
Skeletal Maturity Considerations
Clinical Tip 6 – Assessing Skeletal Age
When planning treatment, clinicians must consider skeletal age vs chronological age:
Open growth plates (physes, apophyses) means the child should be treated as a paediatric patient
When closed growth plates are observed, the child may follow adult ACL guidelines regardless of chronological age.
Assessment methods: growth spurts, parental height, Tanner staging, or imaging (hand/wrist X-rays).
Children nearing skeletal maturity may follow adult return-to-sport protocols.
Rehabilitation in Prepubescent Children
Clinical Tip 7 – Five Considerations
Use playful, home-based programs with variation to prevent boredom.
Use single-leg hop and strength tests cautiously (larger error margins).
Focus on movement quality over symmetry indexes in young children.
Apply standard adult return-to-sport criteria only in near-mature athletes.
Use validated, age-specific outcome measures like Pediatric International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS) for tracking progress.
Frequently Asked Questions About Paediatric ACL Injuries
1. How common are ACL injuries in children?
ACL injuries are increasingly common in youth sports, especially in activities that involve pivoting, cutting, and jumping such as soccer, basketball, and gymnastics. Learn more about our approach through Sports Injury Physiotherapy in Burlington.
2. Can ACL injuries be prevented in young athletes?
Yes. Programs like FIFA 11+ for Kids that combine strength, balance, and movement training can significantly reduce ACL and other lower-limb injuries. We incorporate these principles into our On field Physiotherapy Injury Prevention programs for young athletes.
3. What are the signs of an ACL tear in children?
A “pop” at the time of injury, rapid swelling (haemarthrosis), knee instability, and difficulty continuing activity are common signs. If your child is showing these symptoms, our Knee Physiotherapy team in Burlington can help with early diagnosis and treatment.
4. Do children always need surgery for ACL tears?
Not always. In some cases, children may benefit from conservative rehabilitation until skeletal maturity. Surgery may be delayed to avoid damage to growth plates. We provide effective Non-Surgical Physiotherapy options to help children stay active safely.
5. How long does recovery take after an ACL injury in young athletes?
Recovery varies. With physiotherapy, many return to activity in 6–9 months, while surgical cases may require 9–12 months before full return to sport. Our ACL Rehabilitation programs in Burlington are tailored to speed safe recovery.
6. What makes ACL injuries in children different from adults?
Children’s skeletal immaturity means they may present with unique injuries and need age-specific rehab strategies. Also, children may not describe their symptoms well, and their joints are naturally more flexible, which makes imaging and diagnosis trickier. Therefore, assessment tools and return-to-sport criteria must be adapted for children. Our team provides specialized Pediatric Physiotherapy in Burlington to address these challenges.
7. Where can I get ACL injury treatment in Burlington?
At Cogent Physical Rehabilitation Center, our physiotherapists specialize in youth sports injuries, ACL rehabilitation, and return-to-sport testing.
Book an appointment with a Burlington physiotherapist.
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Sources
Aarden et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med 2018;52:422–438.
Fabricant PD et al. Development and validation of a pediatric sports activity rating scale: the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Am J Sports Med. 2013 Oct;41:2421-9.
Kocher MS et al. Reliability, validity, and responsiveness of a modified international knee documentation committee subjective knee form (Pedi-IKDC) in children with knee disorders. Am J Sports Med. 2011;39:933–939.
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