Pediatric ACL injuries: treatment and challenges

The number of publications on treatment of anterior cruciate ligament (ACL) injuries in the skeletally immature population has increased through the past decade [1-6]. However, opinions on whether pediatric ACL injuries should primarily be surgically reconstructed or conservatively treated are still divided within the pediatric orthopedic community [7, 8]. Evidence from high-level studies and randomized controlled trials is lacking [9], which leaves the field open for various treatment algorithms due to the lack of a solid scientific knowledge base. Risk factors for ACL injuries in skeletally immature patients are unknown, although it seems that boys may be more prone to rupturing their ACL before skeletal maturity, while girls have an increased risk through and after puberty [10, 11]. Many authors argue that the incidence of pediatric ACL injuries is rising. However, no epidemiological studies are available to support this statement. Increased awareness and advances in diagnostic methods, in addition to higher participation rates and earlier specialization in sports, may have led to an increase in the incidence of pediatric ACL tears.