ACL injuries in children

The natural history of ligamentous tears of the anterior cruciate ligament (ACL) in children is unfavorable because of the high number of secondary meniscus lesions and early manifestation of osteoarthritis. Although their incidence is still relatively small, the number of ACL tears in children has increased over the last years. There is controversy about the treatment of these lesions, especially considering the long-term conservative approach. On the other hand, the rarity of the cases, with a lack of medium- and long-term data, the variety of surgical procedures and the limited number of basic science studies, do not yet allow to proposing ACL reconstructions in young children (Tanner stages 1 and 2) as a routine surgical procedure. The functional demands of the patient and the complication potential should be considered while indicating the procedure. A precise knowledge of the anatomical specificities of the child’s knee and a large experience in ACL reconstruction surgery should be mandatory when taking care of these injuries. The present review gives a current overview of the management of these lesions in preadolescent children.