What's New in Skeletally Immature ACL?

Anterior Cruciate Ligament (ACL) injuries, while previously thought to be rare in skeletally immature athletes, are being seen in increasing numbers. Due to unsatisfactory results with non-operative or delayed treatment, most patients benefit from early surgical reconstruction. However, surgical management with typical adult methods places the open physes at risk of injury or premature arrest. Appropriate treatment of these patients first requires an accurate assessment of the growth remaining, and a tailored surgical approach based on this assessment. In this review, we present an up to date algorithm for treating these difficult patients. Techniques described include intraarticular extraphyseal, all-epiphyseal, and physeal-respecting transphyseal reconstruction techniques. Unfortunately, despite appropriate surgical intervention, children and adolescents continue to have an elevated risk of subsequent ACL injury. Further high-level studies are needed in this realm to further hone our approach.