The incidence of anterior cruciate ligament (ACL) injuries in paediatric and skeletally immature patients is rising in parallel with the global increase in sports participation. Unlike adults, injuries in young patients pose significant challenges in management, particularly when surgery is required. To date, there are still controversies regarding indications, timing, and the most appropriate surgical techniques for ACL reconstruction.

This current concept review provides an in-depth theoretical background on ACL injury and its management in patients with open physes. In addition, it offers a practical treatment algorithm based on the authors’ experience, research findings, and current evidence-based medicine (EBM).
To optimise outcomes and minimise the risks associated with either conservative or surgical treatment, a thorough understanding of the specific considerations related to paediatric patients is essential.