前十字韧带（ACL）伤害

About ACL Injuries

膝盖受伤是常见的亚g active kids, especially athletes, and a torn anterior cruciate ligament (ACL) — a ligament that helps give the knee its stability — is one of the most common types of knee injuries.

Kids who play contact sports (like football and basketball) or so-called “cutting” sports (like soccer and baseball that feature swift, abrupt movements such as pivoting, stopping, or turning on a dime) are most likely to get ACL injuries.

当一个孩子跳跃和落在脚上时，伤害也会跳跃或“锁定”而不是弯曲，而不是弯曲，在膝关节上施加过大的压力并导致ACL，绳子状带，撕裂或分裂。

Teenage girls are 8 to 10 times more likely than boys to tear an ACL. That’s because girls have different risk factors that make ACL injuries more likely, such as body shape, limb alignment, neuromuscular control, and hormones that might loosen the ligament.

ACL伤害可能是非常痛苦的，导致孩子在脚上不稳定，走路困难。根据儿童的年龄和伤害的严重程度，除了6至12个月的康复之外，撕裂的ACL通常需要手术。

ACL做了什么

ACL是膝关节中的四个主要韧带中的一种，可将其连接到Shinbone（胫骨）和大麻（股骨）。它位于关节内，在kneecap（髌骨）后面，在Shinbone之上，小大肠杆下方。

与PCL（后曲韧带）一起穿过它以形成“X”，ACL有助于在旋转时保持膝盖稳定。

具体而言，ACL将Shinbone保持在适当位置并防止其远离膝盖和大腿移动太远。它还在旋转胫骨时提供稳定性。

迹象和症状

与部分或完全撕裂的ACL的孩子可能或可能没有症状，具体取决于伤害的严重程度。

Most will have some instability when walking, feeling “wobbly” or unable to bear weight on the affected leg. Oftentimes there is pain, which can be very intense, and swelling of the knee joint, which can happen within 24 hours of the tear.

许多孩子们报告了听到“流行”声音 - 韧带撕裂的声音。其他人还报告膝盖感觉比之前的“不太紧张”或更少紧凑。

Diagnosis

在医生的办公室或急诊室，医生将进行体检和成像测试，以确定是否有膝盖伤害，如果是的话，它有多严重。

这些测试可以帮助诊断ACL损伤：

• Lachman test.在此考试期间，一个孩子将在他或她的背上躺下，受影响的膝盖抬起并以20到30度角弯曲。然后，医生将一只手放在小腿上，另一只手在大腿顶部，施加压力向前移动胫骨。如果它移动太远，它可以发出撕裂的ACL。
• 前抽屉测试。During this test, the hip is flexed at 45 degrees and the knee at 90 degrees. The examiner grasps the back of the shin, just below the knee, placing index fingers on hamstring tendons and thumbs on the side of the kneecaps to feel any shift of the knee joint and surrounding areas while attempting to pull the tibia forward.

To properly diagnose ACL injuries, doctors usually perform these tests in combination with or in addition to other physical exams.

虽然可能采取X射线来确定损伤的程度，但它们只能通过图像骨骼进行成像，因此只能确认膝盖中的骨骨折存在。一个MRI, which images tissue (like ligaments and muscles), can confirm a partial or complete ACL tear so some doctors will order one to confirm a diagnosis.

治疗

治疗ACL损伤取决于孩子的年龄和伤害的类型。如果孩子仍在增长，外科医生希望确保手术不影响增长板块。生长板是长骨头末端的显影组织，如胫骨和股骨。仍然增长的孩子们有“开放”的增长板材，而那些已经达到骨骼成熟度的人有“封闭”的增长板块。

When a child stops growing, the growth plate hardens (ossifies) along with the rest of the bone. Girls tend to stop growing earlier than boys; their growth plates usually close around ages 14 to 15, while boys’ growth plates close later, at around ages 16 to 17.

If a child has reached skeletal maturity, the surgeon will drill a small tunnel down through the femur to reach the inside of the knee joint. Surgeons replace the torn ACL with tissue from the patient’s own body (usually bone from the kneecap and shinbone with tendon in between) or with donor tissue (called an allograft) from the Achilles tendon in the foot. The new ACL tissue is fed through the tibia and femur tunnels and is secured in the proper area with screws or other fixtures.

如果孩子是年轻的，外科医生将专注于通过收紧缩小生长钢板髂菌条，厚的组织带跨越腿部从下骨盆到Shinbone的底部。在膝盖上收紧这种组织有助于稳定膝盖并防止胫骨向前移动太远。

After surgery, a child will need to walk with the assistance of crutches, limit physical activity, and wear a full-leg brace for 4 to 6 weeks, depending on what the surgeon advises.

Rehab and Recovery

Recovery from ACL surgery is a lengthy process that can take from 6 months to a year. Rehabilitation (“rehab”) therapy is needed to help heal the knee and to:

• restore range of motion
• 恢复膝盖，大腿和胫骨的力量（并预防萎缩，肌肉组织的崩溃）
• reduce pain and swelling
• 改善平衡

Most kids undergo rehab at a center three times a week, with daily exercises they practice at home. Accelerated rehab programs require more frequent therapy and speed up recovery to 4 to 6 months.

在恢复的早期阶段，一个孩子将不得不穿腿部支撑，然后是膝盖支撑，以降低恢复膝盖的风险。保持膝盖冰和升高可以帮助减少肿胀。反柜台或处方止痛药和抗炎药可以帮助孩子们处理痛苦并感觉更舒适。

While most sports are off limits — especially the activity that caused the injury in the first place — kids can do some low-impact activities that may be fun and even therapeutic, like swimming, bike riding, or protected running. Talk to your doctor about what activities might benefit your child.

帮助你的孩子应对

被告知你不能做你喜欢的东西 - 就像跑步或踢足球，野生曲棍球或垒球 - 对任何孩子来说都是一个毁灭性的打击。来自ACL伤害恢复的孩子可能会感到生气，沮丧，甚至沮丧，特别是如果他们不再与他们的朋友一起参加团队运动。

But in the meantime, there are ways to still feel like part of the team. Keeping score, being a coach’s assistant, or bringing water to the games may help. If your child doesn’t want to do these, suggest starting a hobby, like playing the guitar, painting, drawing, or another activity that won’t put too much strain on the knee. Low-impact activities, like swimming, are another option.

及时，孩子们可以回到他们所爱的东西。但如果你的孩子在恢复期间继续感到生气或沮丧，鼓励他或她与学校心理学家或顾问交谈，他们可以帮助你的孩子应对并展望更好的日子。

审查：Alfred Atanda, Jr, MD
Date reviewed: October 2012