Controversies in the Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Patients

A Literature Review of Current Treatment Options

Amr Selim, MBChB (Hons), MRCS, MSc Orthopaedics; Humza Tariq Osmani, BSc (Hons), MBBS (Dist), MRCS; Wasim Khan, MBChB, MRCS, Dip Clin Ed, MSc, PhD, FRCS(Tr&Orth); Ioannis Pengas, MBChB, MRCS, FRCS (T&O), MPhil (MedLaw & Ethics), MD


Curr Orthop Pract. 2022;33(2):197-203. 

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Nonsurgical treatment has proven to result in detrimental outcomes with long-term consequences. Surgical intervention in terms of reconstruction has its own problems of early and perhaps unacceptable failure rates as well as the potential of physeal damage either through drilling, metalwork crossing or abutting the physis.

In the cohort before physeal closure, ACL repair remains an interesting proposition, which if proven sufficient even for a reasonable period, could delay definitive ACL reconstruction to an age bracket where the revision risk is more acceptable. In patients with open physes who have proximal peel-off ACL tears, early repair in a suitable and favorable environment may yield satisfactory results in the short-, medium-, and even in the long-term with further options available should they be required. At this time, with variable results and heterogenous studies, more level 1 studies would be helpful to further guide surgeons in this population group.