{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:52:21Z","timestamp":1792698741601,"version":"4.5.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:label\/><jats:p>Tailored surgical strategies for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients are presented, emphasizing techniques to minimize growth plate damage and ensure stability. As ACL injuries in youth increase, delaying surgery can lead to joint damage and poor recovery outcomes. Using magnetic resonance imaging\u2010based assessments of skeletal maturity, the authors propose the \u2018over\u2010the\u2010top (OTT)\u2019 approach with lateral tenodesis, adapted for three growth stages: prepubescents, young adolescents and older adolescents. For prepubescents, the extra\u2010physeal approach avoids growth plate drilling; for young adolescents, the supra\u2010physeal technique places tunnels above the growth plate; and for older adolescents, the trans\u2010physeal method mirrors adult techniques, as growth plates are closing. The minimally invasive OTT technique preserves hamstring insertion, ensures isometric graft placement, and allows for combined intra\u2010 and extra\u2010articular procedures to improve rotational control and protect the graft. Clinical outcomes highlight high return\u2010to\u2010sport rates, minimal growth disturbances, and low failure rates, although older adolescents show higher graft failures due to activity levels. Various adaptations of the OTT and lateral tenodesis techniques utilizing hamstring tendons provide promising solutions for addressing ACL injuries in skeletally immature patients, ranging from prepubescence to late adolescence. Assessing skeletal age and estimating remaining bone growth are essential for selecting the most appropriate surgical method. The biomechanical principles and positive clinical results observed across different patient groups highlight these techniques as effective, safe and attractive options for managing these challenging cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12607","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T03:53:46Z","timestamp":1738641226000},"page":"3510-3522","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Age\u2010specific over\u2010the\u2010top techniques for physeal sparing anterior cruciate ligament (ACL) reconstruction in skeletally immature patients: Current concepts for prepubescents to older adolescents"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-1798","authenticated-orcid":false,"given":"Alberto","family":"Grassi","sequence":"first","affiliation":[{"name":"II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5543-2124","authenticated-orcid":false,"given":"Kyle A.","family":"Borque","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Houston Methodist Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6963-7144","authenticated-orcid":false,"given":"Mitzi S.","family":"Laughlin","sequence":"additional","affiliation":[{"name":"Houston Methodist Academic Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation University of Nebraska Medical Center Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2941-1407","authenticated-orcid":false,"given":"Stefano","family":"Zaffagnini","sequence":"additional","affiliation":[{"name":"II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200409001-00010"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514559912"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07331-0"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0749-8063(91)90003-G"},{"key":"e_1_2_12_6_1","first-page":"1","article-title":"Anterior cruciate ligament rupture in skeletally immature patients","volume":"6","author":"Cancino B","year":"2022","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000002236"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1069-5"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2015-000013"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13051501"},{"key":"e_1_2_12_11_1","volume-title":"Rate of second injuries after ACL reconstruction and lateral tenodesis with hamstrings in 318 teenager patients at an average follow\u2010up of 7 years","author":"Grassi A","year":"2024"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-05948-z"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-3402794"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/19417381211014487"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520986875"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-195909000-00030"},{"key":"e_1_2_12_17_1","volume-title":"Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children","author":"Herring J","year":"2008"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-008-0119-8"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200609001-00012"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.01327"},{"key":"e_1_2_12_21_1","unstructured":"KoeblerJ. 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