Surgical options for anterior cruciate ligament reconstruction in the young child

Injury to the anterior cruciate ligament (ACL) is becoming increasingly common in the skeletally immature population. Historically, there was a reluctance to operate on skeletally immature patients due to potential damage to the physis and subsequent growth disturbances; however, more recently, ACL reconstruction techniques specifically developed for this young population have shown good outcomes and low complication rates. In this article, we briefly discuss the modifiable and non-modifiable risk factors for ACL injury in children, options for conservative management for ACL rupture, and outcomes for delayed operative management. The main focus of the manuscript is to describe three operative technique options designed for ACL reconstruction in skeletally immature patients and to review the literature on outcomes and complications of these techniques. Two of these techniques, namely the Modified MacIntosh and the all-epiphyseal techniques, are often referred to as physeal-sparing, while the third, i.e. the transphyseal technique, is not. While different in approach and technique, these procedures have been shown to produce good outcomes and minimal complications in the skeletally immature population. Despite these positive reports, it is also essential to be aware of potential complications and the potential risk of recurrence.