According to the WoSCC database, from 2003 to 2023, 2269 authors from 753 institutions in 41 countries published 637 articles on ACL reconstruction in children and adolescents in 94 journals. Compared to 2003, the number of articles published in 2023 has increased several times, and research on ACLR in children and adolescents has increased steadily over the past 20 years. The increasing trend in the number of papers suggests that ACLR in children and adolescents is attracting more and more attention and interest among researchers.

637 papers on ACLR in children and adolescents selected from the WoS database were analyzed. As shown in Fig. 2, the number of papers on ACLR in children and adolescents has fluctuated and increased over the past 20 years.

Trend of published papers related to ACL injuries and reconstructions in children and adolescents over the past 20 years

Table 2 shows that over the past 20 years, the 10 countries or regions with the highest number of publications related to ACLR injuries and ACLR in children and adolescents. Six collaboration groups were formed in the 19 most productive countries (≥ 5) (Supplemental Fig. 1). The United States published the most articles (n = 434), followed by France (n = 40) and Canada (n = 36). The United States has the most citations. It is worth noting that although Australia is not in the top three articles (n = 26), it ranks second in number of citations, while Canada ranks third in number of citations. There is a slight difference in the number of papers and the number of citations in other countries. In addition, the United States is the country with the highest number of published articles and citations, indicating that the United States is a leader in research on ACL reconstruction in children and adolescents. Finally, Swedish and Danish researchers have published additional papers in recent years (Supplemental Fig. 2) that provide us with some research directions.

Table 3 lists the 10 most common institutions in the study for ACLR in children and adolescents over the past 20 years. Philadelphia Children’s Hospital had the largest number of articles (n = 59) and citations, followed by New York Special Surgery Hospital (n = 50) and Boston Children’s Hospital (n = 40). Philadelphia Children’s Hospital and New York Special Surgery Hospital are the largest contributors to research on ACLR in children and adolescents, and their combined output is more than six times that of Cincinnati Children’s Hospital, which has long been one of the top three in the United States. Philadelphia Children’s Hospital ranks first in the number of articles and citations. On the surface, the institution has good academic capabilities. From the top 10 large research institutions, it can be concluded that all of the top 10 institutions are American institutions. Our research shows that there are more facilities in the United States dedicated to reconstructing ACL injuries in children and adolescents. 62 of the most productive institutions (papers ≥ 5) form 4 collaboration clusters. The largest collaborative cluster of research institutions based at the Children’s Hospital of Philadelphia (Supplemental Fig. 3).

Table 4 lists the 10 authors with the most published articles. The 10 authors published a total of 227 articles, accounting for 35.64% of the total. Ganley, from the Children’s Hospital of Philadelphia in Pennsylvania, USA, ranked first in the study of anterior cruciate ligament injury reconstruction in children and adolescents, followed by Kocher from Boston Children’s Hospital, Department of Orthopedic Sports Medicine, Harvard Medical School, Boston, Massachusetts, USA. So if you want to continue following the development of ACLR in children and adolescents, you can follow these authors: Ganley, Theodore J. And Kocher, Mininder s. The number of cited papers is very high, which shows that their work has attracted the attention of researchers. However, through VOSviewer analysis, we can see that the collaboration between authors of collaborative clusters is not sufficient (Supplemental Fig. 4).

In “Trends in Pediatric ACLR From the PHIS Database” the Kocher team’s most widely cited article, Kocher et al. analyzed data from pediatric hospitals in the United States from 2004 to 2014 and found the number of ACL reconstructions increased 5.7-fold, whereas orthopaedic surgeries increased 1.7-fold; there was a 2.8-fold increase in ACL reconstructions relative to total pediatric orthopaedic surgeries. This is significantly higher than the overall orthopedic surgery growth rate (1.7 times). The annual rate of ACL reconstruction was 32.4 per 1000 orthopedic surgeries, a nearly three-fold increase compared to the total number of orthopedic surgeries.

Moreover, 80% of the top 10 authors hail from the United States, a country renowned for its plethora of exceptional researchers dedicated to the study of ACL injury and reconstruction in children and adolescents. This underscores the profound importance these researchers place on advancing knowledge in this field.

A total of 94 journals have published articles on ACL injuries and reconstructions in children and adolescents. The top 10 journals published a total of 412 articles, accounting for 64.68% of the total, as shown in Table 5. Among them, the American Journal of Sports Medicine (99) was the journal with the largest number of published articles, followed by Orthopedic Journal of Sports Medicine (75) and Journal of Pediatric Orthopedics (71). The reason why these journals are in the top 10 is, firstly, because the research topics they cover are most relevant to the reconstruction of ACL injuries in children and adolescents, and relevant researchers are often happy to submit papers to these journals. Secondly, these journals are the most influential professional journals in the field, and researchers can effectively improve their academic level and research ability by reading the papers published in these journals.

Table 6 shows the 10 most frequently cited papers on ACL injury and reconstruction in children and adolescents over the past 20 years (2 reviews and 8 research articles). These articles were primarily published between 2004 and 2016, and they summarized and analyzed the epidemiology, etiology, treatment and prognosis of ACL injury and reconstruction in children and adolescents. An increase in the rates of ACL reconstruction in individuals with immature skeletal development was noted [5]. Firstly, cruciate ligament injuries are common among young soccer players, particularly female athletes. Secondly, studies have shown that the risk of re-injury following ACLR is closely related to age and activity level, particularly in athletes under 25 years of age returning to high-risk sports [17]. Furthermore, the management of ACL injuries in patients with immature bones remains controversial, but techniques such as epiphyseal preservation and combined reconstruction have shown favorable functional outcomes and low revision rates in preadolescent children [18]. In addition, the literature also mentions the significant increase in knee abduction angle [18] observed in female athletes during the rapid growth phase of adolescence [18,19,20], which may be associated with an increased risk of ACL injury. Finally, the literature indicates that young athletes who return to sports after an ACLR have higher rates of secondary injuries, with a risk 30 to 40 times higher than the initial ACL injury. Therefore, some measures must be taken to reduce secondary injury in this high-risk population [17].

Using VOSviewer, we analyzed 1721 keywords found in titles and abstracts of 637 articles. From this analysis, we identified 5 clusters represented by different colorsn as shown in Fig. 3: red, green, yellow, purple and blue. These clusters were formed by 162 keywords that occurred more than 7 times. Cluster 1 (red) primarily focused on the prognosis and return to sport following ACL reconstruction in children and adolescents. Cluster 2 (green) primarily investigated the risk factors associated with ACL injury in children and adolescents. Cluster 3 (blue) mainly focused on the characteristics of ACL injury and reconstruction in children and adolescents, including open epiphysis, growth and development stage, etc. Cluster 4 (yellow) mainly showed a series of complications of ACL injury Cruciate ligament in children and adolescents. Cluster 5 (purple) focused on the diagnosis of ACL injury. The five most commonly classified were “anterior cruciate ligament injury,” “anterior cruciate ligament reconstruction,” “children and adolescents,” and “skeletally immature patients”. In addition, the keyword time chart (Supplemental Fig. 6) provides valuable information about the publication trends. In this chart, the color yellow represents the newest keywords associated with the average publication, while blue represents the oldest keyword. By analyzing the chart, we observed that the most publications in this field have focused on several key areas. These included “return to sport”, “re-rupture”, “outcome” and “functional prediction after ACL reconstruction”. These results showed that the concept of “function first” was becoming increasingly popular and researchers in related fields were paying more and more attention to the reconstructed functions of the ACL.

Keyword co-occurrence network