Management of anterior cruciate ligament disruptions in skeletally immature patients.

Proper treatment of anterior cruciate ligament injuries in skeletally immature patients is a highly debated topic. More aggressive surgical approaches have been explored as a consequence of the potential long-term detrimental intra-articular effects of nonoperative treatment. Concerns of growth disturbances secondary to physeal injury have been reduced as a result of various alternative surgical techniques. Estimates of the amount of growthplate disruption necessary to induce changes in osseous development have also been attempted. Ultimately, the final decision to intervene surgically is influenced by joint instability and by the patient's symptoms and compliance with nonoperative treatment. Long-term repercussions of severe intraarticular destruction with nonoperative treatment should be compared with the potential detrimental effects of surgery. If more advanced techniques are combined with an increase in clinical awareness of these risk factors, then an earlier surgical approach may be a suitable option.