Combined ACL and ALL anatomic reconstruction in skeletally immature patients: clinical outcomes and growth safety

INTRODUCTION: Surgical management of anterior cruciate ligament (ACL) injuries in skeletally immature patients remains challenging due to the presence of open growth plates and the higher risk of graft failure compared to adults. The addition of an anterolateral ligament (ALL) reconstruction could improve stability and reduce failure risk, but concerns about growth disturbances persist. OBJECTIVE: To determine the graft failure rate, growth safety, and return-to-sport outcomes after combined ACL-ALL anatomic reconstruction using a hamstring graft in skeletally immature patients. We hypothesized that this combined technique would be associated with a low graft failure rate while preserving growth safety and satisfactory functional outcomes. METHODS: We conducted a retrospective monocentric study including 39 patients (bone age