Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction in Pediatric Patients: Surgical Technique

• Published in: Arthroscopy techniques (Amsterdam) Vol. 11; no. 7; pp. e1359 - e1365
• Main Authors: Morin, Vincent, Buisson, Laurent, Pinaroli, Alban, Estour, Gilles, Cohen Bacry, Maureen, Horteur, Clément
• Format: Journal Article
• Language: English
• Published: Elsevier 01-07-2022
• Subjects: Technical Note
• ISSN: 2212-6287; 2212-6287
• DOI: 10.1016/j.eats.2022.03.023

Anterior cruciate ligament (ACL) rupture is a common affliction in the athletic population. In pediatric patients, the immature skeleton with active growth plates is an issue that makes ACL reconstruction surgery technically challenging. The rerupture rate after ACL reconstruction is higher in the pediatric population than in the adult population. The addition of anterolateral ligament (ALL) reconstruction has been shown to be an effective way to reduce the rate of graft rupture and to control rotatory instability (pivot shift). Therefore, it appears necessary to combine ACL and ALL reconstruction in the pediatric population. We describe the surgical steps for combined ACL and ALL reconstruction adapted for young patients with active growth plates.
Video 1
Surgical technique for combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction using continuous graft of semitendinosus and gracilis tendons adapted for pediatric patients. This surgical procedure allows one to perform ACL reconstruction in a patient with an immature skeleton with a limited risk of growth plate injury. The graft fixation in the femur is entirely located in the epiphysis, distally from the growth plate. In terms of the tibia, this technique offers double fixation, comprising fixation from the native insertion of the hamstring tendons and fixation achieved with a screw below the growth plate.