Reconstructing the ACL Helps Teen Boy Thrive in Athletics After Injury in Both Knees

September 17, 2019

Jack was 13 and a defender for his travel soccer team when an opponent slide tackled him, causing a collision that tore the anterior cruciate ligament, or ACL, in his left knee.

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Dr. Finlayson, right, with a resident, prepares the femur for graft placement during an ACL repair surgery.

The suburban Chicago family knew where to turn for treatment – Ann & Robert H. Lurie Children’s Hospital – because they had already worked with the orthopaedic team there for treatment for Jack’s older brother, Luke, who has cerebral palsy.

“When Jack was injured we consulted the amazing orthopaedic surgical team at Lurie Children’s,” said Jack’s mother, Ann. “They knew that Dr. Craig Finlayson would be most familiar with Jack’s condition, an ACL tear.”

Treating ACL injuries in all ages, including children with open growth plates, is among Dr. Finlayson’s specialties. An orthopaedic surgeon, he is also surgical director and co-medical director of Lurie Children’s Surgery Center in Northbrook. He is an assistant professor of orthopaedic surgery at the Northwestern University Feinberg School of Medicine.

New Surgical Options for Young Patients

Historically, some orthopaedic providers have delayed reconstruction of a torn ACL in adolescent patients until they are done growing. That’s because traditional reconstruction requires drilling tunnels through bones which can harm the growth plates of the tibia and femur in younger patients, potentially leading to deformity or shortening of the leg.

Newer ACL reconstruction techniques, however, allow surgical teams to operate on young patients like Jack in a way that will allow them to return to their previously active lifestyles while minimizing the risk of damage to the growth plates. Pediatric orthopaedic surgeons such as Dr. Finlayson can offer these procedures.

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Kaitlin Holtgrave, DPT, Jack’s physical therapis (left); Dr. Craig Finlayson, orthopaedic surgeon; and Emily Worobec, senior certified athletic trainer; were all crucial to Jack’s recovery following two ACL tears.

There are two different types of growth plate-sparing ACL reconstructions. In the youngest group of patients (some as young as 6 years old), the patient’s iliotibial band is re-routed around the lateral aspect of the knee, through the knee joint and back to the tibia. This creates a combined intra- and extra-articular graft that does not require any drilling into the bones.

Because Jack’s bone age predicted that he still had a significant amount of growth remaining, Dr. Finlayson performed this type of surgery.

The procedure was successful, but it was only the beginning of a long recovery. The procedure kept Jack out of school for just a week, after which he began twice weekly therapy with the Lurie Children’s Physical Therapy team as well as his home exercise program, Jack was able to return to the soccer field “extremely strong,” Ann said.

While a grueling time for the family, Ann said Dr. Finlayson’s “approach and attitude were amazing. He always directed his conversation to Jack first, and then to us, his parents, which really made Jack feel comfortable and encouraged.”

Another Setback Before a Fresh Start

Shortly after starting a new soccer season, Jack, then 14, endured another heartbreaking injury. He was hit during a match, this time tearing the ACL in his right knee. Unfortunate but not uncommon, patients who have sustained an ACL injury have a much greater risk for injury in the opposite knee, even after rehabilitation, said Emily Worobec, Senior Certified Athletic Trainer in the Division of Orthopaedic Surgery and Sports Medicine at Lurie Children’s.

“It was so unfortunate, the timing,” Ann said.

For the family, there was no question they would return to Dr. Finlayson and the Lurie Children’s rehab team for additional treatment. This time, due to Jack’s continued maturation, Dr. Finlayson performed an alternative growth plate-sparing procedure, called an intra-epiphyseal reconstruction. With the assistance of fluoroscopy, tunnels are created that traverse through the epiphysis of the bone and enter the knee at the sites of the ACL’s attachments. The ends of the graft are passed into the two tunnels, where the new ACL graft will eventually incorporate into the bone. This allows the surgeon to closely reproduce the anatomy of the native ACL while avoiding the growth plates.

Moving Forward

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Jack successfully took up tennis following ACL reconstruction on both of his knees with Dr. Craig Finlayson.

Once again, Jack endured a year of rehabilitation and physical therapy focused on strengthening his core muscles and legs, as well as improving his balance and agility to regain function and protect his reconstructed knees from further injury. While his therapeutic team opened the door to him returning to soccer, Jack decided to take up tennis instead. A natural athlete and hard worker, Jack and his doubles partner placed third in their conference.

“I don’t think his motivation would be the same if he didn’t have the encouragement from Dr. Finlayson and the therapeutic team,” Ann said. “He’s doing phenomenally.”

Learn more about the division of orthopaedic surgery