ACL Program | Research and Innovation

Boston Children’s providers are leading the way in all aspects of ACL research—from less invasive surgical techniques that minimize arthritis risk to psychological considerations and injury prevention and return-to-play protocols.

Pioneers in ACL Surgery for Growing Bodies

In the past, orthopedic surgeons and sports medicine physicians did not routinely recommend surgery for children and young teens with torn ACLs. That's because the conventional surgical approach required the surgeon to drill tunnels through the grown plate. (The growth plate, or physis, is the area at the end of the bone that produces new bone tissue and is responsible for bone growth).

This type of ACL surgery can damage the growth plate and interfere with the patient’s future growth. The standard recommendation was to wait until after puberty to complete the surgery. The problem with this approach is that a child with a torn ACL risks further injury to the knee with even everyday activity.Dr. Lyle Micheli pioneered a surgical procedure for ACL repair in growing children and adolescents

In 1979, Lyle Micheli, MD, director of the Sports Medicine Division, devised a surgery to replace the ACL of a toddler born without the ligament. He avoided the growth plate by transferring the patient’s iliotibial band (the ligament running from the hip to the shin) around and into the knee. This operation has been subsequently used in younger children with ACL tears, with excellent long-term success and no growth disturbances.

Subsequent studies lead by Micheli and Mininder Kocher, MD, MPH, associate director of the Sports Medicine Division, have documented the success of this surgery and other procedures developed to manage the risk of growth plate injury in children and adolescents.

A Less Invasive Way to Treat ACL Tears

Boston Children’s Hospital orthopedic surgeon Martha M. Murray, MD, has developed a new technique—bridge-enhanced® ACL repair—that uses stitches and a bridging scaffold to stimulate healing of the original ligament. The bridging scaffold is a bio-engineered sponge saturated with the patient’s own blood to stimulate healing and to promote clotting, which allows the torn ACL tissue to regenerate. The technique eliminates the need to harvest a graft of the patient’s hamstring tendon.

Learn more about the BEAR® clinical trial.