Contralateral Anterior Cruciate Ligament Injuries Following Index Reconstruction in the Pediatric Athlete

Purpose of Review: The purpose of this review is to discuss relevant anatomy and pathoanatomy in the knee following anterior cruciate ligament reconstruction, risk factors for contralateral ACL tear, and mechanisms of contralateral injuries in the pediatric population. Recent Findings: Contralateral ACL rupture rates following ACL reconstruction (ACLR) range from 4% to 42%. Pediatric patients show increased risk compared with adults, likely due to inherent anatomical differences along with biomechanical and neuromuscular changes that occur in both the operative and contralateral knees following index ACLR. Pediatric athletes who return to sport more quickly have been found to be at increased risk for contralateral tears, as have athletes who participate in cutting and pivoting sports. Contralateral tears tend to occur via non-contact mechanisms. Summary: Pediatric patients are at increased risk of contralateral ACL injury following index ACL reconstruction compared with adults. Further study is warranted to determine appropriate biologic, functional, and rehabilitative parameters gauged toward preventing contralateral ACL tear while minimizing time lost from sport.