All-Inside, All-Epiphyseal Autograft Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Athlete.

Abstract

We present an all-inside, all-epiphyseal anterior cruciate ligament (ACL) reconstruction technique with use of a hamstring autograft for skeletally immature athletes. Identify and mark subcutaneous landmarks to aid with anatomic orientation throughout the operation and to assist with socket placement. Harvest a hamstring autograft to create a four-strand autograft in the standard fashion or, if you prefer, perform a posterior hamstring harvest. Prepare a four-strand hamstring autograft using suspensory cortical fixation devices-a reverse-tensioning button (ACL TightRope RT; Arthrex, Naples, Florida) on the femoral side and an attachable button system (ACL TightRope ABS, Arthrex) on the tibial side. Create blind-ended intra-articular sockets in the femur and tibia using the center-center footprint positions while avoiding the physeal plates. Pass the hamstring autograft through the anteromedial portal and dock it in the femoral and tibial sockets; engage the cortical button on the femur, dock the graft, and then perform final fixation on the tibial side. The patient's age and maturity level dictate the progression of rehabilitation, and parents and caregivers are encouraged to regularly participate in the child's rehabilitation regimen. Research is ongoing to evaluate the clinical and radiographic outcomes following ACL reconstruction in skeletally immature athletes with use of this technique¹⁹. IndicationsContraindicationsPitfalls & Challenges.