Intrasubstance tears of the anterior cruciate ligament (ACL) have been recently reported with increasing frequency in skeletally immature patients. Epidemiologic data from a large integrated health care system demonstrates an incidence of 0.11 per 10,000 at 8 years of age that gradually increases to 2.42 per 10,000 by 14 years of age.¹ Although ACL injuries in children and adolescents are relatively rare, an increased rate of ACL reconstructions in this population has been observed over the last 20 years.² This increase in pediatric ACL surgery is thought to be commensurate with increasing injury incidence²; however, this phenomenon may also represent a change in management preferences from nonoperative to operative because of improved surgical techniques³,⁴,⁵,⁶,⁷,⁸,⁹,¹⁰,¹¹,¹² and increased awareness that meniscal and chondral pathology may be associated with nonoperative¹³,¹⁴,¹⁵,¹⁶,¹⁷,¹⁸,¹⁹ or delayed surgical treatment.²⁰,²¹,²²,²³,²⁴,²⁵

Pediatric knee injuries, including ACL tears, present a public health problem because of the detrimental effects they can have on the health and well-being of young athletes.²⁶ ACL reconstruction in skeletally immature patients has been shown to be effective at restoring normal knee function and stability.⁴,²⁷ Surgical reconstruction techniques can be categorized into three groups: transphyseal, physeal-sparing, and hybrid techniques. The type of surgical treatment should be determined by the patient’s physiologic and skeletal age at the time of injury. Appropriate treatment is paramount in avoiding iatrogenic growth disturbance and for return to sports participation and overall quality of life.