Abstract
This paper presents a six-year-old boy with midsubstantial rupture of the anterior cruciate ligament (ACL). ACL injuries are rare in children younger than eight years. The outcome of non-operative treatment, primary ACL repair and extra-articular reconstruction is unsatisfactory. Transphyseal reconstructive surgery in patients who is not near skeletal maturity can result in leg-length discrepancy and angular deformity. For patients who are near skeletal maturity, transphyseal ACL reconstruction is performed at the appropriate skeletal age. For patients who do not meet the skeletal age requirements for transphyseal reconstruction, modification of sports and activity is the preferred treatment.