Pediatric ACL injuries: navigating the challenges and advancements in surgical reconstruction and rehabilitation strategies

INTRODUCTION: ACL reconstruction in pediatric patients presents unique challenges due to the presence of growth plates and the potential for growth disturbances. Various surgical techniques have been developed to address these concerns, including physeal-sparing techniques such as the modified MacIntosh procedure and the all-epiphyseal technique, as well as the minimally invasive All Inside Technique. However, the occurrence of growth abnormalities and long-term outcomes in this population require further investigation.EVIDENCE ACQUISITION: This review examines existing literature on growth plate injuries and complications following ACL reconstruction in pediatric patients. A comprehensive search of relevant articles was conducted, including meta-analyses and case series, to gather evidence on the incidence and types of growth disturbances, surgical techniques employed, and functional outcomes.EVIDENCE SYNTHESIS: The analysis reveals that growth disturbances after ACL reconstruction can manifest as limb overgrowth, limb shortening, and angular malformation. Limb overgrowth appears to be independent of the surgical technique used, while limb shortening may result from misplacement of bone blocks or hardware across the growth plates. Valgus malalignment is the most common deformity observed. Physeal-sparing and transphyseal techniques show similar rates of growth abnormalities, highlighting the need for caution in surgical decision-making.CONCLUSIONS: ACL reconstruction in pediatric patients requires careful consideration of growth plate preservation and choice of surgical technique. While favorable functional outcomes and high patient satisfaction have been reported, further investigation through randomized controlled trials is needed to address methodological limitations and refine the management of ACL injuries in this population. Proper rehabilitation and guidance are crucial for a successful return to sports and minimizing the risk of re-injury. Future research should focus on understanding the risk factors, technical features, and underlying mechanisms associated with growth disturbances to develop strategies that minimize these complications and optimize outcomes for young athletes.