Current management approaches for anterior cruciate ligament tears in young athletes

Abstract

Anterior cruciate ligament (ACL) tears are among the most frequent serious knee injuries in young athletes and often lead to prolonged time away from sport and elevated risk of re‑injury. Purpose was to synthesize contemporary evidence (2015-2025) on diagnosis, operative and non‑operative management, rehabilitation, and return‑to‑sport (RTS) in adolescents and young adults with ACL tears. Narrative review informed by a structured search of PubMed/Medline and Google Scholar using MeSH terms ("anterior cruciate ligament/injuries", "anterior cruciate ligament/surgery", "athletes", "rehabilitation", "platelet-rich plasma", "anterolateral ligament"), limited to english language and human studies. Current guidelines recommend individualized treatment; when surgery is indicated, reconstruction is favored over primary repair due to lower revision risk. Graft choice should consider sport demands and age; evidence suggests slightly lower failure with bone-patellar tendon-bone (BTB) versus hamstrings in some cohorts, though patient‑reported outcomes are comparable. Adjunct procedures such as anterolateral augmentation (ALL/LET) may reduce graft failure and pivot shift in high‑risk patients. PRP shows mixed benefits, with possible modest improvements in early pain and stability but inconsistent long‑term effects. Criteria‑based rehabilitation with delayed RTS (≈9-12 months) and psychological readiness assessment lowers second‑injury risk. Management of ACL tears in young athletes should be individualized, balancing surgical technique, biologic adjuncts, and rigorous criteria‑based RTS testing that integrates strength, hop performance, movement quality, and psychological readiness.