All-Inside, All-Epiphyseal Autograft Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Athlete.

Introduction: We present an all-inside, all-epiphyseal anterior cruciate ligament (ACL) reconstruction technique with use of a hamstring autograft for skeletally immature athletes.

Step 1 Identify Subcutaneous Landmarks: Identify and mark subcutaneous landmarks to aid with anatomic orientation throughout the operation and to assist with socket placement.

Step 2 Harvest The Hamstring Graft: Harvest a hamstring autograft to create a four-strand autograft in the standard fashion or, if you prefer, perform a posterior hamstring harvest.

Step 3 Prepare The Graft: Prepare a four-strand hamstring autograft using suspensory cortical fixation devices-a reverse-tensioning button (ACL TightRope RT; Arthrex, Naples, Florida) on the femoral side and an attachable button system (ACL TightRope ABS, Arthrex) on the tibial side.

Step 4 Prepare The Femoral And Tibial Sockets: Create blind-ended intra-articular sockets in the femur and tibia using the center-center footprint positions while avoiding the physeal plates.

Step 5 Pass And Secure The Graft: Pass the hamstring autograft through the anteromedial portal and dock it in the femoral and tibial sockets; engage the cortical button on the femur, dock the graft, and then perform final fixation on the tibial side.

Step 6 Postoperative Rehabilitation: The patient's age and maturity level dictate the progression of rehabilitation, and parents and caregivers are encouraged to regularly participate in the child's rehabilitation regimen.

Results: Research is ongoing to evaluate the clinical and radiographic outcomes following ACL reconstruction in skeletally immature athletes with use of this technique.

What To Watch For: IndicationsContraindicationsPitfalls & Challenges.