Tibial Physeal-Respecting, All Epiphyseal ACL Reconstruction Technique in Skeletally Immature Athletes

There has been an increase of anterior cruciate ligament (ACL) injuries in the pediatric population due to multiple factors. The potential complications of traditional ACL reconstructions have led to the development of physeal-sparing techniques. The goal with this technique is to preserve growth potential while provide long-term knee stability. This procedure involves a small, centrally-placed tibial transphyseal suture fixation with an all-epiphyseal graft tunnel on the tibial side along with an all-epiphyseal femoral tunnel. Over a 7-year period of this physeal-respecting technique being performed, no clinically significant growth disturbances, angular deformities, or major leg length discrepancies were reported. The most common finding has been mild overgrowth of the surgical side (<15 mm) but has led to no functional concerns. As pediatric ACL injuries continue to rise, improving surgical approaches to enhance both safety and function should remain a priority. However, further research is needed to review patient long-term outcomes.