Management of anterior cruciate ligament tears in skeletally immature athletes

The prevalence of anterior cruciate ligament (ACL) injuries in skeletally immature athletes has increased dramatically over the past decade. Many attribute this to increased training, singlesport specialization and year-round competitive play. ACL injuries most commonly occur in athletic activities that involve cutting, pivoting, jumping and landing. Non-operative treatment consisting of activity modification, physical therapy and specialized bracing may have a role; however, recent data suggest that this may not be optimal in young, active patients. Surgical treatment has become more favorable, specifically for athletes with aspirations of higher-level sports participation. To minimize growth plate disturbances and potential for limb malalignment, the patient’s skeletal age, pubertal status and remaining growth potential must be taken into consideration. We provide a review on how to evaluate, manage and treat the skeletally immature athlete with an ACL injury.