Treatment of Ligament Injuries in Children

Initial Management

The British Journal of Sports Medicine recommends that immobilization, if needed, should be limited to a maximum of 10 days, after which functional treatment should be commenced, for children with ligament injuries 1, 2
Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and swelling in children with ligament injuries, but caution should be exercised as they may suppress the natural healing process, according to the British Journal of Sports Medicine 4, 5
RICE (Rest, Ice, Compression, Elevation) is not recommended as a standalone treatment modality for ligament injuries in children, as stated by the British Journal of Sports Medicine 3

The British Journal of Sports Medicine suggests that the use of functional support (brace or tape) is superior to inadequate support such as compression bandages for children with ligament injuries 1
For pediatric patients, a brace is often easier to apply and maintain than taping, according to the British Journal of Sports Medicine 2
Functional support allows controlled loading of damaged tissues while providing protection for children with ligament injuries, as recommended by the British Journal of Sports Medicine 1

Exercise therapy should be started as soon as possible to recover joint functionality in children with ligament injuries, according to the British Journal of Sports Medicine 3
Supervised exercise-based programs are preferred over passive modalities as they stimulate recovery of functional joint stability in children with ligament injuries, as stated by the British Journal of Sports Medicine 4
Exercise therapy for children with ligament injuries should focus on proprioception 3, strength 6, coordination 7, and functional movements 3

The Journal of the American College of Radiology notes that pediatric ligament injuries differ from adult injuries as children's ligaments are often stronger than their growth plates 6
For children under 5 years, radiographs may be necessary if there are risk factors present to rule out fractures or growth plate injuries, according to the Journal of the American College of Radiology 6
Treatment decisions for children with ligament injuries should consider the child's developmental stage and activity level, as recommended by The Journal of the American Academy of Orthopaedic Surgeons 8

Regular follow-up is essential to monitor healing and adjust treatment as needed for children with ligament injuries, according to the British Journal of Sports Medicine 3
Gradual return to normal activities for children with ligament injuries should be implemented based on resolution of pain and swelling 5, recovery of range of motion 1, and restoration of strength 3

Manual joint mobilization may be beneficial when combined with exercise therapy if range of motion restrictions persist in children with ligament injuries, as suggested by the British Journal of Sports Medicine 1, 2
Surgical intervention is rarely indicated for pediatric ligament injuries and should be reserved only for cases that do not respond to comprehensive functional treatment, according to the British Journal of Sports Medicine 3
If symptoms persist beyond expected healing time or if instability continues in children with ligament injuries, further evaluation with MRI may be warranted, as recommended by the Journal of the American College of Radiology 9

Prolonged immobilization can lead to joint stiffness, muscle atrophy, and delayed recovery in children with ligament injuries, according to the British Journal of Sports Medicine 1
Returning to full activities too soon may result in re-injury or chronic instability in children with ligament injuries, as stated by the British Journal of Sports Medicine 3
Overlooking associated injuries (such as growth plate injuries) which may require different management in children with ligament injuries, as noted by the Journal of the American College of Radiology 6