Anterior cruciate ligament injuries in children

The knowledge of pediatric ACL injuries and their treatment has made significant progress over the last three decades. This evolution was initiated by the advances made by orthopedic sports medicine pioneers in the 1980s and 1990s. At that time, most surgeons were confronted with a negative selection of children with chronic ACL injuries and secondary soft-tissue damage. Therefore, specific pediatric surgical techniques were successfully developed and proved to be safe if used in a technically correct way. Nowadays they are used on a large scale, but due to the pediatric specificities, surgery remains nevertheless a challenge. Surgery-related complications still do occur, although at an acceptably low frequency (<2 %). The last decade showed that nonoperative treatment may be suitable for 30-50 % of patients, whereas others may develop rapidly secondary soft-tissue injuries. Today pediatric ACL injuries are increasingly recognized and physicians are confronted with many different situations at different evolutionary stages. Thus, future progress has to be made to select the right treatment at the right moment for the right patient. This chapter presents the challenges of pediatric ACL injuries, their clinical appearance, diagnosis, and treatment options.