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Clinical Orthopaedics and Related Research®

, Volume 468, Issue 7, pp 1971–1977 | Cite as

All-epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

  • J. Todd R. Lawrence
  • Andrea L. Bowers
  • Jonathan Belding
  • Stephanie R. Cody
  • Theodore J. GanleyEmail author
Surgical Technique

Abstract

Background

Treating ACL injuries in prepubescent patients requires balancing the risk of chondral and meniscal injuries associated with delaying treatment against the risk of growth disturbance from early surgical reconstruction. Multiple physeal respecting techniques have been described to address this vulnerable population; however, none restore the native ACL attachments while keeping the graft and fixation entirely in the epiphysis.

Description of Technique

We describe a technique of all-epiphyseal ACL reconstruction for use in prepubescent skeletally immature patients. Intraoperative CT scanning with three-dimensional (3-D) reconstruction was used to confirm the precise localization of the all-epiphyseal femoral and tibial tunnels. The femoral tunnel is drilled entirely in the epiphysis of the lateral femoral condyle. The tibial tunnel is drilled from inside-out to the level of the tibial physis using a retrograde drill. Fixation of the soft tissue graft is achieved with a retrograde interference screw in the tibia and an interference screw in the femur.

Patients and Methods

Case examples are presented for three boys aged 10–12, Tanner Stage 1 development, with a minimum followup of 1 year.

Results

All three patients had stable knees based on Lachman and KT-1000 testing and no evidence of growth disturbance. All had full ROM and symmetric strength for knee flexion and extension. All patients returned to their sports activities using a custom ACL brace.

Conclusions

Although longer-term followup will be necessary, this technique provides for an anatomic all-epiphyseal-based ACL reconstruction using intraoperative 3-D imaging to minimize the risk of growth disturbance.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Guide Wire Femoral Tunnel Tibial Tunnel Interference Screw Growth Disturbance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Nick Wright for support in the development of this technique.

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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • J. Todd R. Lawrence
    • 1
  • Andrea L. Bowers
    • 2
  • Jonathan Belding
    • 3
  • Stephanie R. Cody
    • 1
  • Theodore J. Ganley
    • 1
    • 2
    Email author
  1. 1.Division of Orthopaedic SurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Case Western Reserve School of MedicineClevelandUSA

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