Anterior cruciate ligament injury in the skeletally immature

Injury to the anterior cruciate ligament (ACL) has become one of the most publicized musculoskeletal injuries because of media coverage of its occurrence in elite and professional athletes. Treatment outcomes have vastly improved from advances in diagnostic methods, operative techniques, stronger graft fixation, and accelerated rehabilitation. The lay public has grown to consider this injury as only a "minor" setback to the elite athlete because these stars frequently return to their preinjury level of performance post-ACL reconstruction. Expectations regarding outcome in the general population, as well as the skeletally immature patient, have also magnified. Recent evidence suggests that mid-substance ACL injuries in skeletally immature patients are more common than originally reported and the natural history of these injuries, if the patient returns to a high level of activity, is similar to that of mature patients [I - 6]. Reconstructive techniques are complicated in children because of the potential for physeal arrest. Children face additional pressures from parents, coaches, and peers as their athletic participation intensifies and their performance improves. An ACL injury in a skeletally immature athlete presents a unique challenge for the treating orthopedic surgeon.