Comparison of Anterior Cruciate Ligament Reconstruction Techniques In Adolescents: A Systematic Review of Literature

Background: Anterior cruciate ligament (ACL) injuries in adolescents have increased significantly, with reconstructions in patients under 15 years rising 425% from 1994 to 2006. The skeletal immaturity of this population introduces unique surgical considerations regarding repair technique selection and physeal approach, yet comparative evidence on functional outcomes remains limited.
Methods: We conducted a systematical review of literature on PubMed from 2021 to 2025 comparing functional outcomes of different ACL reconstruction techniques in adolescent patients, with specific focus on single-bundle versus double-bundle repair methods, transphyseal versus physeal-sparing approaches, and the influence of skeletal maturity status on recovery.
Results: Seven studies encompassing 1,054 patients were included. Single-bundle reconstruction was the predominant technique (40.9%), while double-bundle reconstruction was documented in only one case (0.1%). Patients with open physes demonstrated superior functional outcomes compared to those with closed physes across short-and long-term follow-up periods. Single-bundle transphyseal reconstruction in skeletally immature patients yielded the highest functional scores, with weighted mean IKDC scores of 93.1 ± 6.8 short-term and 98.6 ± 2.9 long-term.
Conclusion: Single-bundle transphyseal reconstruction represents an effective surgical approach for adolescent ACL tears, particularly in skeletally immature patients. Skeletal maturity status at the time of surgery serves as an important prognostic factor for functional recovery. However, substantial proportions of unspecified repair techniques and physeal approaches, heterogeneity in functional scoring systems, and broad temporal categorization limit definitive conclusions. Future research should prioritize standardized outcome reporting and patient-level data analysis to better inform clinical decision-making in this population.