Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Patient

Anterior cruciate ligament (ACL) injuries in skeletally immature patients are being observed with increased frequency. The management of these injuries is controversial. Nonreconstructive treatment of complete tears typically results in recurrent functional instability with risk of injury to meniscal and articular cartilage. A variety of reconstructive techniques have been used, including physeal sparing, partial transphyseal, and transphyseal methods using various grafts. Conventional adult ACL reconstruction techniques risk potential iatrogenic growth disturbance because of physeal violation. Growth disturbances after ACL reconstruction in skeletally immature patients have been reported. In this review, I discuss our approach to ACL injuries in the skeletally immature patient. Specifically, surgical techniques in the prepubescent patient and in the adolescent patient are detailed.