Objective: The reconstruction of the anterior cruciate ligament in children is subject of debate in the medical community by growth disorders risk with early reconstruction. However, delaying surgery further increases the risk of intra-articular lesions. The purpose of this monograph is to register new evidence concerning the therapeutic options with special emphasis to the moment of surgery.

 

Data sources: 42 articles were included (2004-2014) on the anterior cruciate ligament approach in children, conservative/surgical treatment, long-term consequences and imaging evaluation.

 

Data synthesis: Delaying the reconstruction is associated with a higher incidence of medial meniscus lesions and the need for surgery doubles by delaying the treatment for 5-12 months and quadruples after 1 year. Transphyseal techniques are applied to individuals who have attained bone maturity, by concerns of injury the physis and growth disorders. However, the dimensions of the perforation does not exceed 3% of the growth plate section and does not occur enlargement of the tunnel, not causing injury. Recently it has been shown that this can be employed in Tanner I/II patients. The surgical techniques that preserve physis are intended to younger patients by the lower probability of iatrogenic disorders of growth. Within these allepiphyseal allows better restore to joint kinematics.

 

Conclusions: The poor outcomes of conservative approach favors surgery that should be carried out to as soon as possible. In the light of current scientific literature, it appears that the transphyseal techniques could be used safely in patients with bone immaturity, enabling better results.

 

Keywords: anterior cruciate ligament, physis, children, knee, skeletal immaturity