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Pediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies

Review Article | Volume 11 | Issue 2 | May-August 2025 | Page: 2-10 | Doria L. Weiss, Alexis Carr, Kevin Berardino, Kevin Quindlen, Rachel Talley-Bruns DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.226 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). Submitted: 01/06/2025; Reviewed: 30/06/2025; Accepted: 06/07/2025; Published: 10/08/2025 Authors: Doria L. Weiss BS [1] […]

Editorial

Volume 11 | Issue 1 | January-April 2025 | Page: 01 | Jayanth S. Sampath DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.210 Authors: Jayanth S. Sampath FRCSEd (Tr & Orth) [1] [1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India. Address of Correspondence Dr. Jayanth S. Sampath, Rainbow Children’s Hospital, Bangalore, Karnataka, India. E-mail: editor.posi.ijpo@gmail.com Editorial The management of […]

Pediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies

Editorial

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Pediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.226

Open Access License: CC BY-NC 4.0

Submitted: 01/06/2025; Reviewed: 30/06/2025; Accepted: 06/07/2025; Published: 10/08/2025

Authors: Doria L. Weiss BS [1] , Alexis Carr BS [1], Kevin Berardino MD [1], Kevin Quindlen MD [1], Rachel Talley-Bruns MD [1]

[1] Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY

Address of Correspondence

Dr. Doria L. Weiss,
Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY.
E-mail: dweiss23@student.nymc.edu

Abstract

Introduction: Anterior cruciate ligament (ACL) tears in pediatric patients are increasingly recognized due to rising sports participation and improved imaging. Given the presence of open physes, treatment decisions must balance the need for knee stability with the risk of growth disturbance. This review outlines current approaches to diagnosis, surgical techniques, graft selection, postoperative rehabilitation, and complications in skeletally immature patients.
Methods: This review summarizes recent literature on pediatric ACL injuries, including epidemiology, injury patterns, surgical management strategies, graft options, rehabilitation protocols, and complication rates. Emphasis is placed on the rationale behind technique selection based on skeletal maturity and long-term outcomes.
Results: Surgical reconstruction has become the preferred treatment for most pediatric ACL injuries to prevent secondary damage and restore knee stability. Several physeal-sparing and transphyseal techniques are available, with selection guided by skeletal age and growth remaining. All-epiphyseal and extraphyseal techniques avoid crossing the physis, while transphyseal reconstruction is safe in adolescents nearing skeletal maturity. Hamstring and quadriceps tendon autografts are most commonly used, while bone–patellar tendon–bone grafts and allografts are generally avoided in younger patients. Graft failure and growth disturbance remain key concerns, with retear rates reaching up to 20% and growth abnormalities occurring in 1–5% of cases. Rehabilitation protocols are evolving toward milestone-based progression, with return to sport typically delayed at least 12 months. However, re-injury rates remain high in this population.
Conclusions: ACL injuries in pediatric patients require a nuanced, age-specific approach. Surgical reconstruction using physeal-respecting or transphyseal techniques offers favorable outcomes when matched to skeletal maturity. Careful graft selection, individualized rehabilitation, and delayed return to sport are essential to optimize results and reduce complications. Ongoing research is needed to refine surgical strategies, compare graft types, and establish evidence-based rehabilitation and return-to-sport guidelines.
Keywords: Paediatrics, Anterior Cruciate Ligament Tears, Epidemiology, Evaluation, Evolving Treatment Strategies

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How to Cite this Article: Weiss DL, Carr A, Berardino K, Quindlen K, Bruns RT. Paediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2): 02-10.

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Editorial

Volume 11 | Issue 1 | January-April 2025 | Page: 01 | Jayanth S. Sampath

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.210

Authors: Jayanth S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Editorial

The management of skeletal dysplasias in children has transformed in recent years thanks to widespread availability of genetic studies in the developing world and a better understanding of the orthopaedic aspects of these complex multi-system problems. It has become a common experience for orthopaedic surgeons to be presented with a genetic report that lists an obscure skeletal dysplasia. This issue of IJPO is aimed to improve the awareness among orthopaedic surgeons of the common skeletal dysplasias, their typical clinical and radiological features, and management.
We present an overview of the principles and practice of orthopaedic surgery in skeletal dysplasias. The issue kicks off with an introduction by Dr Sukalyan Dey and colleagues regarding the definition and classification of skeletal dysplasias. Dr Sangeet Gangadharan follows with a comprehensive outline of the radiological diagnosis and the need for specialised investigations. Dr Arjun Dhawale and co-workers have provided a broad perspective to the assessment and treatment of spinal disorders. The role of growth modulation in deformities around the knee has been covered in detail with case examples by Dr Akash Kumar Ghosh. Our associate editor, Dr Gaurav Garg has pitched in with an excellent overview of hip problems in skeletal dysplasias. Dr Binu Kurian has detailed the management of limb deformities, an article co-authored by Dr James Fernandes from Sheffield Children’s Hospital, a world authority on the subject.
We are proud that the authors are from institutions across the world, each offering a unique perspective to the management of these difficult problems. Please share the articles with your trainees and fellows. IJPO issues are easily downloadable free of charge and in full-text format from our website www.ijpoonline.com
We invite your suggestions and comments for any improvements to the journal. Kindly write to us editor.ijpo@gmail.com or editor@posi.org.in
It is my pleasure to acknowledge the contributions of authors, reviewers, editors, and the backend team who have been instrumental in bringing out this issue. We acknowledge Dr Easwar T Ramani, POSI Webmaster for the cover page artwork which adds interest to the contents of this issue.

Sincerely

Dr Jayanth S Sampath
Editor,
International Journal of Paediatric Orthopaedics

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2025;11(1): 01. https://doi.org/10.13107/ijpo.2025.v11.i01.210

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