The Spectrum of ACL Reconstruction Options for the Pediatric and Adolescent Patient: A Narrative Review

As youth sports participation has increased in recent years, injuries to the anterior cruciate ligament (ACL) are increasingly common in pediatric patients. Historically, ACL reconstructions were delayed in pediatric patients to avoid physeal damage with potential for possible leg-length discrepancy or angular deformity. Current research shows delaying reconstruction or choosing non-operative management is associated with increased rates of meniscal and chondral injuries, persistent knee instability, and low rates of return to previous activity. Early ACL reconstruction with techniques to avoid physeal growth disturbance is now widely accepted amongst physicians. The purpose of this review was to first describe the pediatric ACL in terms of relevant anatomy and biomechanics, physical exam, and diagnostic imaging. Secondly, the importance of skeletal age and concern for physeal injury is then discussed in the context of ACL reconstruction options by skeletal age and remaining growth potential.