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The aim of the study was to examine whether a rupture of the anterior cruciate ligament (ACL) in patients with open growth plates should be treated by surgery or conservatively. An electronic search was performed in MEDLINE, the Cochrane controlled trial register, Embase, and Medpilot. Ten studies including 154 patients were analyzed regarding conservative treatment and 55 studies including 935 patients regarding operative treatment. The mean age for the conservative and operative treatment groups was 12.3 (10-14.4) years and 13.3 (10-15.8) years, respectively. Summing up there were significantly better results concerning Lysholm score (95.5 vs 73.2; p<0.05), instability described by the giving way phenomenon (2.8 vs 89.5%; p<0.05), and regaining former sports activity level (91.2 vs 30.9%; p<0.05) in the operatively treated group. Relative risk for leg length differences more than 1 cm or axis deviation more than 3° after surgery was low (2.1%). Reruptures occurred in 3.8% of the cases. The analyzed data clearly show that operative treatment is superior to conservative management of ACL ruptures in children and adolescents.

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