Partial ACL Injuries in Pediatric and Adolescent Athletes

Partial thickness ruptures of the ACL are quite common in pediatric athletes, with rates of partial tears ranging from a quarter to over half of all cases. Despite this acknowledgment, to date only one investigation has focused on the management of partial ACL injuries in a pediatric population. The management and outcome of partial ACL ruptures are highly linked to diagnostic decision-making of treating orthopedic surgeons in advocating non-operative versus operative management. We recommend a multimodal decision-making process incorporating results from patient history, physical examination, imaging, and a low threshold to performing a diagnostic arthroscopy, if indicated. This diagnostic process serves to help distinguish between injury patterns that maintain the functional integrity of the ACL and those that render the ACL nonfunctional. Athletes with partial injuries that result in ACL insufficiency are best served with a ligament reconstruction surgery. While pediatric athletes with partial ACL ruptures may have improved healing capabilities, persistent ligamentous instability in this active group can lead to significant secondary injuries with concerning adverse effects on lifetime joint health.