Research coverage
Which young athletes are most at risk of re-tearing an ACL
Over 300 patients, sorted by how much growing they had left to do.
What it found
- More than 300 HSS patients who had a primary ACL reconstruction were followed for two years and sorted into three groups by how much skeletal growth they had left.
- Group 1 — mostly elementary and middle school athletes up to 7th grade, with three to six years of growth remaining.
- Group 2 — predominantly 8th and 9th graders, with two to three years of growth remaining.
- Group 3 — high school and young collegiate athletes who were fully grown.
- Group 1 saw a 6% revision rate and a 100% return to sport; Group 3, 6% and 94%.
- Group 2 stood apart: a 20% revision rate and an 86% return to sport.
- Group 1 had an all-epiphyseal hamstring autograft reconstruction — the technique Dr. Green developed with Dr. Cordasco, which uses sockets rather than tunnels.
Presented at the American Academy of Orthopaedic Surgeons 2018 Annual Meeting.
In Dr. Green’s own words
This study shows that our all-epiphyseal technique is successful in treating young athletes who are not yet skeletally mature,
These patients used to be denied surgery because of their age, but we have developed an effective reconstruction technique to get them back in the game.
If an 8th or 9th grader walks into a doctor’s office with a torn ACL, the high risk needs to be communicated to the family,
Conversely, if it’s a younger middle school athlete, the success rate is pretty good.
To achieve optimal results after surgery, we counsel our patients to complete an ACL prevention injury program,
It’s very important that these athletes only return to sports after they have regained great physical shape and learned prevention techniques.
HSS Newsroom · 7 March 2018. Dr. Green is a senior author of the study, with Frank A. Cordasco, MD, MS. Read the original
The research behind it
The 6 most recent of his 31 papers on revision and return to sport, indexed on PubMed under his Hospital for Special Surgery affiliation. Each opens on PubMed.
All 31 of his papers on this subject- A skeletally immature patient with Diamond-Blackfan anemia with Deferoxamine induced bone dysplasia: An analysis on diffusion tensor imaging Skeletal radiology · 2026 Aug 11 · Dr. Green is author 5 of 6
- Increased operative time is an independent risk factor for surgical complications following isolated anterior cruciate ligament reconstruction in skeletally immature patients Journal of experimental orthopaedics · 2026 Apr · Dr. Green is author 3 of 11
- Validation of the ACL Return to Sport after Injury (ACL-RSI) Scale in Pediatric and Adolescent Patients After Medial Patellofemoral Ligament Reconstruction Orthopaedic journal of sports medicine · 2026 May · Dr. Green is author 10 of 11
- Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Prospective Multicenter PLUTO Study The American journal of sports medicine · 2025 Mar · Dr. Green is author 12 of 25
- Variation in Surgical Technique for Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: Data From the JUPITER Prospective Multicenter Study Group Orthopaedic journal of sports medicine · 2025 Feb · Dr. Green is author 3 of 23
- Temporary hemi-epiphysiodesis with tension band plates in skeletally immature patients with genu valgum: Faster correction in patients with more than 2 years of expected time of growth remaining Journal of children's orthopaedics · 2024 Aug · Dr. Green is author 6 of 6