All-Epiphyseal Double-Bundle Anterior Cruciate Ligament Reconstruction for Skeletally Immature Patients

Abstract

The number of anterior cruciate ligament (ACL) reconstructions in skeletally immature patients has been gradually increasing in recent years owing to the poor outcomes of conservative treatment. However, ACL reconstruction in children is a challenging procedure and may lead to severe complications, such as growth disturbance. Although double-bundle (DB) ACL reconstructions are preferable because of their superior clinical outcomes, there are few reports of DB ACL reconstruction in children with open epiphyses. In this Technical Note, an all-epiphyseal sparing DB ACL reconstruction technique, which is considered to help avoid growth disturbance, is described. This procedure does not create a thick tunnel and may facilitate subsequent revision surgery.

Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients

“…For patients with an open physis who had a concomitant injury at the time of ACL injury, patients with a new concomitant injury during the surgery waiting period, or patients hoping for an early return to sports, an all-epiphyseal DB-ACL reconstruction using an HT autograft was implemented. 13 If the central physis closure occurred on both the distal femur and the proximal tibia (dropout sign), 30,39 or complete closure was observed on magnetic resonance imaging, conventional (transphyseal) DB-ACL reconstruction using an HT graft or rectangular tunnel bone–patellar tendon–bone (BTB) ACL reconstruction was implemented. 38…”

“…In the all-epiphyseal DB-ACL reconstruction, 13 a semitendinosus tendon (ST) was initially harvested; the harvested ST was cut in half, and the distal and proximal halves were used for the AMB and PLB, respectively. A small longitudinal skin incision was made above the lateral epicondyle of the femur, and the iliotibial band was incised along the line of the fibers.…”