Current approaches to diagnosing and managing anterior cruciate ligament injuries in skeletally immature patients

The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients is rising, prompting a shift in management strategies. Historically, nonoperative treatment was favoured due to concerns about iatrogenic physeal injury and consequential growth disturbance. However, emerging evidence supports early ACL reconstruction to improve long-term outcomes and reduce complications such as instability, meniscal damage, and early onset arthritis. This review examines the unique anatomical, developmental, and biomechanical aspects of the paediatric ACL, emphasizing the need for early diagnosis and surgical treatment. Surgical management strategies, including physeal-sparing, physeal-respecting, and transphyseal reconstruction techniques are discussed, with particular attention to their application based on the patient's growth potential. Postoperative rehabilitation, tailored to the patient's developmental stage, is crucial for optimizing recovery and preventing long-term complications. A multidisciplinary approach, incorporating early diagnosis, specialist involvement, and collaboration with experienced paediatric physiotherapists, is essential to achieve optimal outcomes in this complex patient population.