Richie Racoon Swimming
Mark Schimmoeller

Jeffrey Guy MD and patient

ACL Surgery Technique Gets Young Athletes Back in the Game

When Mark Schimmoeller was at soccer tryouts in May 2010, he moved to clear a ball and was pushed backward by an opposing player. "I heard and felt a snap as my right knee bent the wrong direction, but I didn't realize how badly I was injured," says Mark.

Mark sat on the sidelines during the remainder of tryouts, but because he could still walk, he went to school as usual the next day.

"When he came home, his knee was hurting badly," remembers Mark's mother, Shirleen. "It was unstable and he said it felt like jelly."

What they didn't know was that Mark's anterior cruciate ligament (ACL) had been torn completely in half. During their first visit to an orthopaedic specialist, they were given several different options, but didn't feel very optimistic about treatment. "We went for a second opinion and felt even worse after that," says Shirleen.

 Shortly after that, Shirleen and her husband, Mark Schimmoeller, Sr., went to a fundraiser at Cardinal Newman High School. The basketball coach, Kevin Rose, recommended that they take their son to see Dr. Jeffrey Guy and Dr. Christopher Mazoué.

Shirleen called the practice and described what had happened to Mark's knee. The person she spoke with said, "That sounds like a challenge. Dr. Guy loves a challenge." The call was transferred to Dr. Guy, who asked, "Can you bring him in right now?"

"It was 4:30 on a weekday," says Shirleen. "I couldn't believe they offered to see Mark so soon. When we got there, Dr. Guy made me feel so comfortable. We left there feeling much better."

With more than 30 million children and teens participating in organized sports in the United States, about three million sports-related injuries occur, with the most common being sprains and strains.

"When tears of the ACL occur in children, they need to be treated differently than we would treat them in older teens or adults," says Dr. Guy.

While these types of injuries are common in sports that involve jumping and twisting, an ACL tear can result in persistent instability of the knee. Traditional treatment has been to brace the knee and prescribe a physical therapy program, along with taking the child out of sports. Until recently, physicians have opted to wait until the child's growth is complete before considering surgery for ACL injuries.

The Schimmoeller family had planned to go on a cruise July 31. Mark had his surgery August 11, 2010 in the Children's Surgery Center at Palmetto Health Children's Hospital and during the surgery, Dr. Guy discovered that Mark also had a torn meniscus. "They were excellent at keeping us informed throughout Mark's surgery," says Shirleen.
 
"Many doctors believe that ACL injuries should be treated conservatively," says Dr. Guy. "Restricting activity is unrealistic for most children," he says. "Children are going to continue to move. A child's activity will put his knees in positions that may damage the underlying cartilage and meniscus."

The risk for skeletally immature patients is that if they have a tear, they can permanently lose function. With more children competing at an earlier age in high-level sports, their knees are subject to stress and injury at greater levels.

The procedure Dr. Guy recommended for Mark Schimmoeller is physeal sparing reconstruction that avoids drilling through the growth plates. "It allows us to go around the growth plates, rather than through them," says Dr. Guy.

Dr. Guy has been performing this procedure for more than 10 years. "During my fellowship I saw the oldest living case of this procedure," he says. "The success rate is high for not requiring an additional procedure."

"I recently had a case where I had performed the ACL surgery on a 9-year-old boy," says Dr. Guy. "Not too long after that, his 13-year-old brother also injured his ACL and required surgery. In both cases I did the physeal sparing reconstruction surgery appropriate for each child's bone age."

When treating a skeletally immature athlete with an ACL injury, Dr. Guy emphasizes that it is important to know the child's chronological age, skeletal age, and physiological age. This determines the procedure he uses to achieve the best outcome for each child.

He says that most patients are able to return to their previous levels of activity and that the risk of physeal growth disturbance is low. In most cases, young athletes may return to their sports activities within about six months of the surgery.