Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

In the past, anterior cruciate ligament (ACL) injury was considered to be rare in children. However, as the participation of children and adolescents in professional sports has increased recently, the rate of ACL injury has risen. Mall et al. demonstrated that among individuals aged less than 20 in the United States, the incidence of ACL injury has surged from 12.22 in the year 1994 to 17.97 per 100000 in the year 2006. It is estimated that 1360490 sport injuries have occurred during the year 2017-2018 among high school athletes in the Unites States. Knee injuries accounted for 14% of high school athletic injuries in this study. Most susceptible knee tissues for injury were reported to be medial collateral ligament (MCL), patellar tendon, knee meniscus, and ACL, respectively (1). Female soccer and male football were the most common sport activities associated with the ACL injury. The injury to the ACL may occur as a result of player to player contact, jumping, or during swift change in the athlete’s direction or speed (2). During managing a child with ACL injury, the physician will face a therapeutic dilemma. Surgical options carry a risk of injury to the growth plates placed around the knee joint, while conservative therapies are associated with a long term risk of knee cartilage damage and degenerative joint diseases. In this paper, we aim to delineate the concept and the management options available for treating a skeletally immature patient with ACL injury.