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Related Concept Videos

Changes in the Appendicular Skeleton with Age01:09

Changes in the Appendicular Skeleton with Age

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The upper and lower limb initially develops as a small bulge called a limb bud, which appears on the lateral side of the early embryo. The upper limb bud appears near the end of the fourth week of development, with the lower limb bud appearing shortly after.
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
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Related Experiment Video

Updated: Jan 16, 2026

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
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Skeletal Maturity Assessment in Pediatric ACL-Reconstruction.

Umile Giuseppe Longo1,2, Mariajose Villa Corta1,2, Federica Valente1,2

  • 1Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy.

Children (Basel, Switzerland)
|September 27, 2025
PubMed
Summary

Pediatric anterior cruciate ligament (ACL) reconstruction is complex due to open growth plates. This review discusses surgical techniques and maturity assessment to improve outcomes and minimize growth disturbances in young athletes.

Keywords:
ACL reconstructionMRI bone agebone agegrowth disturbancepediatric ACL injurypediatric orthopedicsphyseal injuryphyseal-sparing techniqueskeletal maturitytanner staging

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Area of Science:

  • Orthopedic Surgery
  • Pediatric Sports Medicine
  • Skeletal Biology

Background:

  • Anterior cruciate ligament (ACL) injuries in skeletally immature patients present unique challenges due to open physes.
  • Current surgical strategies aim to restore knee stability while minimizing growth disturbances, but consensus is lacking.
  • Optimal timing, technique, and graft selection remain complex for pediatric ACL reconstruction.

Purpose of the Study:

  • To review clinical and radiological tools for assessing skeletal maturity in pediatric patients.
  • To explore how skeletal maturity influences surgical approaches for ACL reconstruction.
  • To summarize complications, guidelines, and controversies in pediatric ACL reconstruction.

Main Methods:

  • Narrative review of current literature on pediatric ACL reconstruction.
  • Analysis of clinical and radiological assessment tools for skeletal maturity.
  • Examination of physeal-sparing, hybrid, and transphyseal surgical techniques.

Main Results:

  • Skeletal maturity assessment is crucial for guiding surgical approach in pediatric ACL reconstruction.
  • Physeal-sparing, hybrid, and transphyseal techniques offer different risk-benefit profiles.
  • Postoperative complications include growth disturbances and graft failure, highlighting the need for careful management.

Conclusions:

  • A multimodal model for skeletal maturity assessment can support individualized treatment strategies.
  • Standardized protocols and high-quality research are essential for improving long-term outcomes.
  • Further investigation is needed to refine surgical techniques and guidelines for pediatric ACL reconstruction.