{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:17:41Z","timestamp":1787912261381,"version":"build-2784847793"},"reference-count":83,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Anterior cruciate ligament (ACL) injuries in skeletally immature patients are becoming increasingly prevalent. These injuries present a unique set of challenges because of the presence of open physes and the associated risk of inducing a growth disturbance with traditional ACL surgical management. This review highlights the relevant anatomy, biomechanics, epidemiology, and risk factors associated with ACL injuries in the skeletally immature population and outlines a thorough evaluation process to determine the appropriate treatment strategy for each individual patient. Although non-operative management may be appropriate in select patients, operative intervention may be best for complete ACL injuries to prevent the risk of secondary injury to associated intra-articular structures. Both physeal-sparing and physeal-respecting approaches may be considered, and the most appropriate treatment option can be determined through assessment of remaining growth. Surgical management of these injuries with the correct approach can result in low complication rates [including retear rates (6%\u201311%) and low growth abnormalities (1%\u20132%)], as well as high rates of return to sport and patient satisfaction.<\/jats:p>","DOI":"10.3389\/fped.2026.1840962","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:03:11Z","timestamp":1785304991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["ACL injuries in skeletally immature athletes"],"prefix":"10.3389","volume":"14","author":[{"given":"Jason G.","family":"Ina","sequence":"first","affiliation":[{"name":"Division of Sports Medicine, Boston Children\u2019s Hospital","place":["Boston, MA, United States"]},{"name":"Department of Orthopaedic Surgery, Rainbow Babies and Children\u2019s Hospital","place":["Cleveland, OH, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mininder S.","family":"Kocher","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Boston Children\u2019s Hospital","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/03635465231205556","article-title":"Prevalence and predictors of concomitant meniscal and ligamentous injuries associated with ACL surgery: an analysis of 20 years of ACL reconstruction at a tertiary care children\u2019s hospital","volume":"52","author":"Pruneski","year":"2024","journal-title":"Am J Sports Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1177\/0363546513518412","article-title":"20 Years of pediatric anterior cruciate ligament reconstruction in New York state","volume":"42","author":"Dodwell","year":"2014","journal-title":"Am J Sports Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2891","DOI":"10.1177\/03635465231185742","article-title":"Major increase in incidence of pediatric ACL reconstructions from 2005 to 2021: a study from the Norwegian knee ligament register","volume":"51","author":"Kooy","year":"2023","journal-title":"Am J Sports Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2500","DOI":"10.1002\/ksa.12397","article-title":"The gender and sex data gap in anterior cruciate ligament injuries in paediatric patients","volume":"32","author":"Engebretsen","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"23259671221129594","DOI":"10.1177\/23259671221129594","article-title":"Youth sports specialization and its effect on professional, elite, and Olympic athlete performance, career longevity, and injury rates: a systematic review","volume":"10","author":"McLellan","year":"2022","journal-title":"Orthop J Sports Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1302\/0301-620X.77B6.7593101","article-title":"The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients","volume":"77","author":"Mizuta","year":"1995","journal-title":"J Bone Joint Surg Br"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4008","DOI":"10.1177\/0363546521990817","article-title":"Early operative versus delayed operative versus nonoperative treatment of pediatric and adolescent anterior cruciate ligament injuries: a systematic review and meta-analysis","volume":"49","author":"James","year":"2021","journal-title":"Am J Sports Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"438","DOI":"10.2106\/JBJS.16.00754","article-title":"Anatomy and biomechanics of the native and reconstructed anterior cruciate ligament: surgical implications","volume":"99","author":"Kraeutler","year":"2017","journal-title":"J Bone Joint Surg Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/0363546516666817","article-title":"Overlap between anterior cruciate ligament and anterolateral meniscal root insertions: a scanning electron microscopy study","volume":"45","author":"Steineman","year":"2017","journal-title":"Am J Sports Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"223","DOI":"10.2106\/00004623-197456020-00001","article-title":"The anatomy and function of the anterior cruciate ligament. 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