Anterior cruciate ligament injury in the skeletally immature athlete

The incidence and prevalence of anterior cruciate ligament (ACL) injury in the school-age athlete is unknown, but ACL injury is certainly not a rarity, especially in girls involved with soccer and basketball. Clinical examinations provide a high degree of specificity and accuracy for the diagnosis. Clinical evaluation includes the determination of physiologic maturity, which is then entered as a factor in the treatment algorithm. Nonsurgical treatment may be definitive or used as a temporizing measure until skeletal maturity. It must include counselling about sports modification to prevent further intra-articular damage. Concerns exist about surgical intervention, which may produce deformity sequelae from physeal invasion. Patients with concommitant unstable meniscal tears require ACL reconstruction. Three types of surgical reconstruction are possible, based on the amount of physeal transgression: physeal sparing, partial physeal, and complete physeal. Treatment decisions must take into account the patient's anatomic and physiological assets and liabilities, and decisions must be made on an individual basis. Promising results have been reported with ACL reconstruction in truly skeletally immature patients, but the number of cases are small and the follow-up is relatively brief.