الفهرس 
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Abstract
The anterior c¬ruciate ligament (ACL) has been one of the most extensively studied ligaments in the body. Its importance in knee function has been emphasized, particularly for athletes who require knee stability in activities such as running, cutting, and kicking. (1)
Tears of the anterior cruciate ligament (ACL) are uncommon injuries in the skeletally immature person. It was once thought that complete ACL disruptions occurred only after growth plate closure. The strength of the ACL fibers have been reported to be stronger than its insertion and therefore trauma to the knee in this age group generally results in fracture or epiphyseal injury. Over the past 20 years, complete midsubstance tears of the ACL in the skeletally immature have been reported with increased frequency. This increase is probably secondary to increased clinical suspicion, improved radiographic imaging, and an increase in participation in high demand ACL sports at an earlier age. (2-6)
Management of these injuries requires familiarity with methods to determine maturity, the basic science of physeal injury, and the options available for appropriate treatment of these active adolescents. (7).
Nonoperative treatment results in poor compliance and activity limitations, and poses has the risk of additional meniscal injury and early arthrosis due to knee instability. On the other hand, arthroscopic ACL reconstruction poses the risk of growth disturbance due to growth plate injury caused by creating the transphyseal tunnel through the distal femur and proximal Tibia(8)
Surgical techniques to address anterior cruciate ligament insufficiency in skeletally immature patients include primary repair, extra-articular tenodesis, transphyseal reconstruction, partial transphyseal reconstruction, and physical sparing reconstruction. (9-13).
Intra-articular reconstruction of the anterior cruciate ligament has been successful in adults; however, drilling across an open growth plate is a cause of concern because it may lead to the formation of an osseous bridge, resulting in premature physeal closure, limb-length discrepancy, and angulation of the involved extremity. (14)
Until now, there are no definite guidelines for choice of the surgical techniques for repair of ACL injury in open physes regarding the possible advantages and disadvantages and the most appropriate for each age group and type of rupture.