Essential Surgical Techniques
Anatomic, Transepiphyseal Anterior Cruciate Ligament Reconstruction
Kyle E. Hammond, MD; John W. Xerogeanes, MD; Dane C. Todd, MD

Overview

Introduction 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.

Results 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 Indications

Contraindications

Pitfalls & Challenges

Introduction

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 …


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