Anterior cruciate ligament reconstruction in skeletally immature knees: an anatomical study

The purpose of this study was to anatomically evaluate anterior cruciate ligament (AL) reconstruction ate anterior cruciate ligament (ACL) reconstruction techniques in skeletally immature knees. Four cadav-techniques in skeletally immature knees. Four cadaveric knees from 2 skeletally immature children were used. After preoperative magnetic resonance imaging (MRI), various ACL reconstruction techniques were performed. On the tibial side, 30 degrees, 45 degrees, and 60 degrees tunnels were made; on the femoral side, a transtibial femoral tunnel was made, and over-the-top placement was used. After reconstruction, specimens underwent MRI imaging and were sectioned for descriptive analysis. The 30 degrees epiphyseal tunnel is feasible in older children, the standard 45 degrees tibial tunnel threatens the anteromedial proximal tibial physis and the tibial tubercle apophysis, and the 60 degrees vertical tunnel violates centrally in the proximal tibial physis. Both the transtibial femoral tunnel and the over-the-top placement are near the posterior distal femoral physis and perichondrial ring. When an interference screw is used for fixation, the physis is difficult to avoid. We recommend giving careful attention to technical details during ACL reconstruction in skeletally immature knees.