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. 2025 Apr 23;11(1):40.
doi: 10.1186/s40798-025-00844-7.

Management of Anterior Cruciate Ligament Injuries in Children and Adolescents: A Systematic Review

Hongfu Jin  1   2 , Nouman Tahir  1   2 , Shide Jiang  3 , Herasimenka Mikhail  4 , Volotovski Pavel  4 , Masoud Rahmati  5 , Seung Won Lee  6 , Wenfeng Xiao  7   8 , Yusheng Li  9   10
Affiliations

Management of Anterior Cruciate Ligament Injuries in Children and Adolescents: A Systematic Review

Hongfu Jin et al. Sports Med Open. .

Abstract

Background: Due to rising sports participation, anterior cruciate ligament (ACL) tears are increasingly prevalent in children and adolescents. This systematic review aimed to evaluate and summarize the management strategies for ACL injuries in children and adolescents.

Methods: A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library databases was conducted to identify studies reporting outcomes of ACL injuries in children and adolescents. Key outcomes were synthesized descriptively, including knee instability, secondary damage, growth disturbances, and return-to-sport (RTS) rates.

Results: A total of 7,507 publications were initially screened, with 105 studies involving 8294 children or adolescents satisfying the inclusion criteria. Conservative treatments were associated with elevated rates of knee instability (35.85-100%), secondary meniscal and cartilage damage, and long-term degenerative changes. Conversely, surgical interventions, including physeal-sparing and transphyseal techniques, demonstrated superior outcomes with lower instability rates (0-7.41%), fewer complications, and higher RTS rates (83.4-92.6%). Pooled RTS rates for conservative treatments were 44.0% (95%CI: 0.018-0.927), while physeal-sparing ACL reconstruction showed a pooled RTS rate of 92.6% (95%CI: 0.732-1.000) and transphyseal ACL reconstruction reported an RTS rate of 83.4% (95%CI: 0.722-0.924).

Conclusion: Conservative management of ACL injuries in children and adolescents is linked to higher rates of knee instability, secondary meniscal and cartilage damage, and degenerative changes. In contrast, surgical interventions, such as physeal-sparing and transphyseal techniques, yield better outcomes in knee stability, complications reduction, and RTS rates. However, risks such as graft rupture, repeat surgeries, and potential growth disturbances emphasize the importance of tailoring surgical approaches to the patient's growth stage and anatomical characteristics.

Keywords: ACL; Anterior Cruciate Ligament; Paediatric; Skeletally Immature; Surgery.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: All data sources used in this systematic review are publicly available published literature. Therefore, ethics approval and informed consent are not applicable. Consent for Publication: None. Competing Interests: The authors declare that the research was conducted without any commercial or financial relationships construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart for the screening and selection of included studies
Fig. 2
Fig. 2
Forest plots of the pooled return-to-sport rate of studies reporting the results of conservative treatments. Abbreviations: RTS: return to sport; ES: Effect size; CI: confidence interval
Fig. 3
Fig. 3
Forest plots of the pooled return-to-sport rate of studies reporting physeal-sparing anterior cruciate ligament reconstruction results. Abbreviations: RTS: return to sport; ES: Effect size; CI: confidence interval
Fig. 4
Fig. 4
Forest plots of the pooled return-to-sport rate of studies reporting the results of transphyseal anterior cruciate ligament reconstruction. Abbreviations: RTS: return to sport; ES: Effect size; CI: confidence interval
Fig. 5
Fig. 5
Management of anterior cruciate ligament injuries in children and adolescents. Abbreviations: ACL: Anterior Cruciate Ligament; MRI: Magnetic Resonance Imaging
See this image and copyright information in PMC

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