Surgeons at Johns Hopkins Children’s Center are no longer waiting when it comes to surgical reconstruction for pediatric patients with ACL tears. “We now try to treat these patients acutely, rather than waiting for the growth plates to close,” says R. Jay Lee, assistant professor of orthopaedic surgery at Johns Hopkins Children’s Center. Lee is working on multiple research projects and clinical trials to continue to advance the surgical treatment of pediatric ACL injuries. 

While growth plates remain a concern during pediatric ACL reconstruction, even in the rare case of a resulting growth disturbance, Lee says, growth can be modulated by tethering the growth plate or, in older children, using osteotomies to correct the deformity. “We now know the longer we wait, the more instability episodes a patient may have, and the more cartilage and meniscal injuries patients develop,” he says.

To reduce the likelihood of growth disturbance, Lee is studying physeal maturation in the knee. “We are always trying to predict when we can safely violate a growth plate without causing complications,” Lee says. 

Lee has used MRI to characterize the process of physeal maturation in the knee of patients from ages 6 to 19. He found that the normal human knee closes in a uniform way, which can aid surgical decision-making by showing surgeons when they can safely violate a growth plate. “When one area of the physis demonstrates early signs of closure, it indicates the physes are closing as a whole,” Lee explains. 

Lee is also participating in a clinical trial for patients ages 10 to 16 that will use autologous chondrocyte implantation to restore cartilage in the knee. “The goal is to see if young patients benefit from reimplantation of cartilage grown from their own cells,” Lee says. Johns Hopkins is 1 of 10 centers participating in the trial, which Lee hopes will yield better outcomes than the traditional treatment of microfracture. 

In addition, Lee is involved in the biomechanical testing phase of another clinical trial on the surgical technique for ACL repair. “In the future, we are going to try to avoid the physes and reconstruction entirely,” Lee says. “Research points to the value of trying to retension the remaining, native tissue instead, to get the tissue to heal.” 

Pediatric patients can benefit significantly from the innovative research and multidisciplinary approach at Johns Hopkins, says Lee. “In addition to the physician, there are many others who weigh in with their experience. There is a depth of expertise and access to extensive resources that you don’t find everywhere.”