Smart ACL Reconstruction for Young Athletes: Protecting Growth, Restoring Performance

ACL injuries in children and adolescents are on the rise—and delaying treatment can lead to serious joint damage. This article highlights modern, growth-friendly surgical techniques tailored to a young athlete’s stage of development, using MRI to guide the safest and most effective approach.

The featured method, the over-the-top (OTT) technique with lateral tenodesis, is adapted across three growth phases:

• Prepubescents – Growth plates are protected with an extra-physeal approach (no drilling).
• Young adolescents – Tunnels are placed just above the growth plates (supra-physeal).
• Older adolescents – A trans-physeal approach is used, similar to adult procedures.

This minimally invasive technique preserves hamstring function, improves knee stability, and allows for precise graft placement—reducing the risk of failure. Clinical results show high return-to-sport rates, minimal growth disturbances, and excellent outcomes overall.

These age-specific strategies provide a safe, effective path to recovery—protecting both the knee and the future growth of young athletes.