[Ruptures of the anterior cruciate ligament (ACL) during growth]

Tears of the anterior cruciate ligament (ACL) in skeletally immature patients with open physes are becoming more frequent. The two main variants of this lesion include tibial eminence fractures with an avulsion of the bony avulsions of the ACL on the tibia and midsubstance ligament injuries. The treatment of bony avulsions is generally accepted. In complete midsubstance tears conservative treatment is insufficient, resulting in multiple giving way episodes and meniscal lesions. Controversy exists regarding the surgical treatment of complete midsubstance ruptures. Especially in younger patients with wide open physes, the risk of a growth disturbance due to transphyseal drilling has not been completely evaluated. In patients approaching physeal closure intraarticular ACL replacement using an autogenous bone-patellar tendon-bone graft has been shown to yield good short-term to mid-term results. There is a growing concern regarding the long-term outcome of ACL grafts with higher rerupture rates being suspected in children compared to adults. For these reasons more clinical and experimental data are needed in forthcoming studies.