It can happen in almost any sport. For Khyon Gillespie, it was football. He was 12 years old and already an up-and-coming football prodigy. His whole life revolved around the sport, along with his plans for the future. But an instant of twisting the wrong way in a game had left him with a torn ACL, or anterior cruciate ligament, one of the central ligaments that holds the knee together. Khyon was devastated.
“He was having nightmares about not playing and crying,” his mother, Nahkia, said. He knew of professional football players who were permanently sidelined by a torn ACL, and he thought his dream of being a football player was over. Until recently, it would have been.
A torn ACL can’t simply be sewn back together again; it has to be replaced with other tendon or ligament tissue. The surgeon drills vertical holes into the ends of the patient’s femur and tibia, feeds the new tendon into those holes, and anchors each end with screws.
That’s the adult approach, but it cannot be used in young children, especially those in early adolescence, as their skeletons are still growing. Each young bone has a growth plate at its end that generates new bone tissue until it hardens into bone itself as the body stops growing.
Growth Plate Concerns
According to Carl Nissen, MD, a sports medicine surgeon at Connecticut Children’s Elite Sports Medicine, athletes who have two or more years of growth left require a different approach.
“Damage to the growth plates can result in leg-length discrepancies or other deformities,” Dr. Nissen explained. “In some cases, one side of the leg may stop growing while the other continues to grow, resulting in a crooked leg.”
Because of that risk, the traditional approach to younger patients with a torn ACL was to have them wear a brace and refrain from sports until their skeletons were finished growing and they could safely have the surgery. For Khyon, there would be no way to take three or four years off of football and expect a career.
But surgeons at Connecticut Children’s Elite Sports Medicine had an option for him: a relatively new surgical technique called physeal-sparing ACL reconstruction. There are a number of different versions of this technique, corresponding to different stages of bone growth. First, orthopedic surgeon Matthew Milewski, MD, removed the torn ligament and then harvested part of Khyon’s hamstring tendon to replace it. He wrapped the tendon around itself several times, like braiding a rope for extra strength, then he inserted it into holes carefully drilled above Khyon’s growth plate, and the tendon was passed across the protected area and secured.
Physeal-sparing techniques are still relatively new, having developed over the past five or 10 years, and in some parts of the country are not widely used. That’s partly because it requires extra training and skills, and it involves more of an investment in following patients long term.
In Khyon’s case, following him is an exciting process. Now 17, he is entering his senior year at Capital Preparatory Magnet School in Hartford and is a running back for the school’s football team. Last season, he scored 25 touchdowns and had 1,750 yards rushing, more than 10 times the national average—an astonishing accomplishment for an appreciative young man.
“The operation didn’t just heal me,” Khyon said. “It made me better, stronger and faster.”
For more information or to contact our care professionals, please visit the Division of Orthopedics at Connecticut Children’s Medical Center’s webpage.