Purpose: To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. Methods: A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than 6 months of follow-up were excluded. Study quality was assessed, and data were collected on clinical outcome, growth disturbance, and secondary joint damage. Results: We identified 47 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence of growth disturbance yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. Conclusions: The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. Although physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. Level of Evidence: Level IV, systematic review of Level II, III, and IV studies. © 2011 Arthroscopy Association of North America.
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