This retrospective case series followed 18 skeletally immature patients (average age 12.8 years) treated non-operatively for complete midsubstance ACL tears. The study asks: are the outcomes of conservative ACL management acceptable in children with open physes? Minimum follow-up was 36 months, with an average of 51 months from injury to evaluation.
When a child or adolescent with open physes tears the ACL, the instinct to avoid surgery and protect the physis is understandable — but this paper shows the cost of that decision.
In this series, 89% of conservatively managed skeletally immature patients had fair or poor functional outcomes, and nearly two-thirds developed secondary meniscal damage or early radiological degeneration within 4–5 years.
The clinical decision rule this paper supports: non-operative ACL management in active, skeletally immature patients produces unacceptable rates of instability, meniscal injury, and early joint degeneration. When you see a young athlete with a confirmed complete ACL tear and open physes, the evidence favors early surgical stabilization over prolonged conservative management. The growth plate risk of a physeal-sparing reconstruction is lower than the cumulative cost of chronic instability.
This paper is one of the foundational studies that shifted practice toward offering ACL reconstruction in children, and it directly informs current guidelines favoring surgery over prolonged conservative care in high-demand skeletally immature patients.
This retrospective case series followed 18 skeletally immature patients (average age 12.8 years) treated non-operatively for complete midsubstance ACL tears. The study asks: are the outcomes of conservative ACL management acceptable in children with open physes? Minimum follow-up was 36 months, with an average of 51 months from injury to evaluation.
When a child or adolescent with open physes tears the ACL, the instinct to avoid surgery and protect the physis is understandable — but this paper shows the cost of that decision.
In this series, 89% of conservatively managed skeletally immature patients had fair or poor functional outcomes, and nearly two-thirds developed secondary meniscal damage or early radiological degeneration within 4–5 years.
The clinical decision rule this paper supports: non-operative ACL management in active, skeletally immature patients produces unacceptable rates of instability, meniscal injury, and early joint degeneration. When you see a young athlete with a confirmed complete ACL tear and open physes, the evidence favors early surgical stabilization over prolonged conservative management. The growth plate risk of a physeal-sparing reconstruction is lower than the cumulative cost of chronic instability.
This paper is one of the foundational studies that shifted practice toward offering ACL reconstruction in children, and it directly informs current guidelines favoring surgery over prolonged conservative care in high-demand skeletally immature patients.