Transepiphyseal Anterior Cruciate Ligament Reconstruction in Pediatric Patients: Surgical Technique

T he prevalence of anterior cruciate ligament (ACL) tears in children and adolescents is relatively low due to ana-tomic and biomechanical factors that predispose skele-tally immature knees to bone injury rather than ligament tears.17 Nevertheless, ACL tears in this age group appear to be increas-ing.1,7,8,12,14-16,18 Management of these injuries presents a unique challenge; evidence in the literature indicates that the outcome of nonoperative treatment of ACL tears in skeletally immature patients is poor.1,9,11,14,15 Conversely, surgical intervention may cause iatrogenic physeal injury, which can result in leg-length discrepancy or angular deformity.6,11,13,14 Management decisions are complicated by deficiency in the basic science on physeal response to injury and by the limitations of the clinical studies that document surgical treatment for ACL insufficiency in chil-dren and adolescents. Despite these uncertainties, a rational approach based on current understanding of normal growth and developmen