Our technique for physeal-sparing, anatomic anterior cruciate ligament (ACL) reconstruction reliably produces femoral tunnels that are of adequate length and that safely avoid the femoral physis without the addition of time-consuming surgical methods or substantial utilization of fluoroscopy.
Step 1: Preoperative Planning
Obtain radiographs and MRI of the knee as well as an anteroposterior radiograph of the hand (to obtain a bone age).
Step 2: Patient Setup, Portal Placement, and Graft Harvest
The affected knee must be able to flex at least 90° with the end of the operative table lowered, in order to properly visualize the anatomy of the ACL femoral footprint.
Step 3: Prepare ACL Footprint and Establish Far Anteromedial Portal
Maintain soft-tissue remnants at both the femoral and the tibial footprint in order to individualize the anatomy.
Step 4: Identify Extra-Articular Landmarks and Prepare Femoral Tunnel
Visualize and palpate your previously marked popliteal sulcus and lateral epicondyle; these landmarks are the crucial extra-articular points for establishing a safe femoral tunnel.
Step 5: Prepare Tibial Tunnel
The tibial tunnel can be safely drilled in a transphyseal manner in skeletally immature patients.
Step 6: Fix Graft
Use the Arthrex ACL TightRope RT for femoral fixation.
Step 7: Postoperative Care
As a skeletally immature athlete differs from a more mature athlete in several important ways, alter the postoperative protocol accordingly.
Our clinical experience has corresponded to our MRI-based findings from our original study14, and we have not observed any physeal or chondral injuries leading to growth disturbances from our femoral tunnels.
What to Watch For
Pitfalls & Challenges