{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:02:40Z","timestamp":1787169760070,"version":"build-2736575974"},"reference-count":83,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Anterior cruciate ligament (ACL) injuries in skeletally immature patients pose unique clinical and surgical challenges due to the presence of open physes and ongoing growth. In recent years, multiple surgical strategies have been developed to restore knee stability while minimizing the risk of growth disturbances. However, clinical decision-making remains complex due to the lack of consensus regarding the optimal timing, technique, and graft selection for this population. This narrative review outlines the current clinical and radiological tools used to assess skeletal maturity and explores how maturity status informs surgical approach, with particular emphasis on physeal-sparing, hybrid, and transphyseal techniques. We summarize postoperative complications\u2014including growth disturbances and graft failure\u2014while highlighting current guideline recommendations and ongoing controversies. Lastly, we propose a multimodal model for skeletal maturity assessment to support individualized treatment strategies and emphasize the need for standardized protocols and high-quality research to improve long-term outcomes in pediatric ACL reconstruction.<\/jats:p>","DOI":"10.3390\/children12091186","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T12:18:18Z","timestamp":1757074698000},"page":"1186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Skeletal Maturity Assessment in Pediatric ACL-Reconstruction"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4063-9821","authenticated-orcid":false,"given":"Umile Giuseppe","family":"Longo","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariajose","family":"Villa Corta","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7006-2888","authenticated-orcid":false,"given":"Federica","family":"Valente","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ruzzini","sequence":"additional","affiliation":[{"name":"Orthopedic Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"D\u2019hooghe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Aspetar Hospital, Doha P.O. Box 29222, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Samuelsson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Sahlgrenska University Hospital, 431 30 Gothenburg, Sweden"},{"name":"Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, G\u00f6teborgsv\u00e4gen 31, 405 30 Gothenburg, Sweden"},{"name":"Sahlgrenska Sports Medicine Center, SE-411 01 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7275-4050","authenticated-orcid":false,"given":"Frank A.","family":"Cordasco","sequence":"additional","affiliation":[{"name":"Sports Medicine Institute, Hospital for Special Surgery, 770 Lexington Avenue, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Sydney Orthopaedic Research Institute, Level 2, 500 Pacific Highway, St Leonards, Sydney 2066, Australia"},{"name":"The Children\u2019s Hospital at Westmead, Hawkesbury Road, Westmead, Sydney 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","first-page":"2371","article-title":"Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents","volume":"87","author":"Kocher","year":"2005","journal-title":"J. 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