Our 14-year-old son tore his ACL playing soccer. He was told by the surgeon not to run, jump, or do any pivoting activities. Our son swears he has not played soccer, basketball, or any other activities he wasn’t supposed to. Even so, he still reinjured his knee and now has a meniscus tear to add to the damages. We’re not sure if we should ground him or accept him at his word. What would you advise?

More and more children are showing up with ACL tears. This may be because there are more children participating in sports, in more demanding contact sports, and in year-round sports activity. With better diagnostic imaging, earlier diagnosis is now possible.

Children treated for ACL tears are routinely told not to engage in any activities that could put their already injured knee at risk for further damage. Like your son, they are advised to avoid running, jumping, or any activities that involved pivoting or cutting motions of the knee.

Despite these guidelines, significant additional injuries are still reported. It’s not clear if this is because the children ignore the counsel of their surgeons or if the everyday activities of children this age are enough to cause ongoing damage.

There is a tendency for children this age to have more ligamentous laxity (looseness) anyway, so it’s possible that without an intact ACL, just normal movement increased the risk of other soft tissue injury. And, of course, everyone is aware that children find interesting and creative ways to do what they want to without exactly violating the activity guidelines given to them. And perhaps they do so without realizing the full effect of their actions.

The idea that “kids will be kids” is hard to get away from. Their decision-making processes are not adult and studies show we can’t expect them to function like mini-adults.