[Paediatric and Adolescent ACL Injuries]

Children with open growth plates should not simply be regarded or managed as "small adults". A thorough understanding of the paediatric knee and its growth, along with the anatomical, hormonal, and neuromuscular changes occurring in children during maturation, is one of the key factors in the diagnosis, decision-making, and monitoring of skeletally immature patients with anterior cruciate ligament (ACL) injuries. Timely and accurate diagnosis and treatment of these ACL injuries are crucial to protecting the long-term integrity of the child's knee with regular reassessments being required to provide each individual patient with the best possible care. In the case of surgical treatment, the surgical technique must be adapted to the open growth plates. Once the growth plates have closed in adolescents and teenagers, surgery can be performed using adult techniques. However, in this age group, an extremely high rate of recurrent injury must be expected (up to 30% ipsilateral re-ruptures or contralateral primary ruptures). The aim of this article is to present the current understanding of paediatric and adolescent ACL injuries, including challenges in their diagnosis and treatment with a particular focus on associated injuries.