Skeletal Maturity Assessment in Pediatric ACL-Reconstruction

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.