儿童前交叉韧带损伤：当前概念综述
简介
儿童前交叉韧带（ACL）损伤并非成人损伤的缩小版，需兼顾骨骼生长与运动专项化背景。本综述整合了当前诊断方案、膝关节形态与神经力学危险因素，并评估了保守治疗、一期修复及多种重建技术的管理策略。关键发现：儿童特有临床与影像学表现需谨慎解读；保守治疗仅适用于特定病例，一旦出现持续性不稳应立即转向手术；ACL重建仍是金标准，但面临生长干扰、移植物高失败率、对侧断裂及…
英文摘要
BACKGROUND/OBJECTIVES: Anterior cruciate ligament (ACL) tears in children and adolescents are occurring at the intersection of skeletal growth and often early sports specialization, requiring a specialized approach, as pediatric ACL injury is not merely a scaled-down version of adult injury. METHODS: This review synthesizes the current understanding of diagnostic protocols, evolution of knee morphology and neuromechanical risk factors characteristic of the pediatric population. It further examines the spectrum of specific management strategies including conservative approaches, primary repair and various reconstruction techniques, alongside rehabilitation, prevention and follow-up procedures. RESULTS: In the diagnostic phase, pediatric-specific clinical and imaging findings must be carefully interpreted. Certain anatomical and neuromuscular characteristics seem to be linked to injury. Management remains complex, requiring a delicate balance between restoring stability and sparing bone growth. While conservative treatment may be attempted in specific cases, it must be promptly redirected toward surgical intervention if persistent instability occurs. Consensus on optimal surgical strategies remain impeded by the lack of robust evidence. Anterior cruciate ligament reconstruction (ACLR) still faces challenges such as growth disturbances, high graft failure, contralateral rupture rates and the biological process of graft remodeling. However, ACLR currently remains the gold standard compared to ACL repair. Tailored rehabilitation and robust prevention programs are needed. CONCLUSIONS: The management of ACL rupture in the pediatric population remains complex and constrained by important evidence gaps. Continued refinement of management strategies and future prospective, multicenter pediatric studies are needed.