Physeal Sparing ACL Repair using Knotless Suture Anchor Technique for Pediatric ACL Injuries

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 57-60 | Manit Arora, Frederick Weitz

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.720

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 25 Jan 2025, Review Date: 13 Feb 2025, Accepted Date: ?? 2025 & Published Date: 30 Jun 2025

Author: Manit Arora [1], Frederick Weitz [2]

[1] Department of Orthopaedics and Sports Medicine, Fortis Hospital Mohali, Punjab, India,
[2] Department of Orthopaedics, Ernst-Mortiz-Arndt-Universitat Greifswald, Pihlajalinna, Finland

Address of Correspondence

Dr Manit Arora,

Department of Orthopaedics, Fortis Hospital Mohali, Mohali – 160 022, Punjab, India.

E-mail: manit_arora@hotmail.com

Abstract

Pediatric ACL injuries are rising, and the ACL tear in an open physis is becoming more common. Traditional ACL reconstruction techniques, whether physeal sparing or transphyseal, are associated with good outcomes but carry the risk of growth arrest due to femoral and tibial bone drilling. We describe a novel technique for ACL repair in pediatric ACL patients, which prevents tibial bone drilling completely and is physeal sparing in the femur. This technique is suitable only for ACL injuries near ACL’s femoral attachment. The technique is well established and documented in adult population. For the femoral fixation Swivelock anchor screw is used. This provides a stable fixation of the ACL in femur with no risk of violating the growth plate through drilling or hardware. This should theoretically minimize the risk of growth plate arrest.
Keywords: Pediatriac, ACL, ACL injuries, Physis

References

1. Shaw L, Finch CF. Trends in pediatric and adolescent anterior cruciate ligament injuries in Victoria, Australia 2005-2015. Int J Environ Res Public Health 2017;14:599.
2. Werner BC, Yang S, Looney AM, Gwathmey FW Jr. Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop 2016;36:447-52.
3. Weitz FK, Sillanpää PJ, Mattila VM. The incidence of paediatric ACL injury is increasing in Finland. Knee Surg Sports Traumatol Arthrosc 2020;28:363-8.
4. Dunn KL, Lam KC, Valovich McLeod TC. Early operative versus delayed or nonoperative treatment of anterior cruciate ligament injuries in pediatric patients. J Athl Train 2016;51:425-7.
5. Smith ID, Irfan A, Huntley JS, Spencer SJ. What is the best treatment for a child with an acute tear of the anterior cruciate ligament? J Paediatr Child Health 2018;54:1037-41.
6. Mouton C, Moksnes H, Janssen R, Fink C, Zaffagnini S, Monllau JC, et al. Preliminary experience of an international orthopaedic registry: The ESSKA paediatric anterior cruciate ligament initiative (PAMI) registry. J Exp Orthop 2021;8:45.
7. Perkins CA, Willimon SC. Pediatric anterior cruciate ligament reconstruction. Orthop Clin North Am 2020;51:55-63.
8. Pierce TP, Issa K, Festa A, Scillia AJ, McInerney VK. Pediatric anterior cruciate ligament reconstruction: A systematic review of transphyseal versus physeal-sparing techniques. Am J Sports Med 2017;45:488-94.
9. Trivedi V, Mishra P, Verma D. Pediatric ACL injuries: A review of current concepts. Open Orthop J 2017;11:378-88.
10. Faunø P, Rømer L, Nielsen T, Lind M. The risk of transphyseal drilling in skeletally immature patients with anterior cruciate ligament injury. Orthop J Sports Med 2016;4:2325967116664685.
11. International Olympic Committee Pediatric ACL Injury Consensus Group, Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, et al. 2018 international olympic committee consensus statement on prevention, diagnosis, and management of pediatric anterior cruciate ligament injuries. Orthop J Sports Med 2018;6:2325967118759953.
12. Seil R, Weitz FK, Pape D. Surgical-experimental principles of anterior cruciate ligament (ACL) reconstruction with open growth plates. J Exp Orthop 2015;2:11.
13. Wong SE, Feeley BT, Pandya NK. Complications after pediatric ACL reconstruction: A meta-analysis. J Pediatr Orthop 2019;39:e566-71.
14. Mäkelä EA, Vainionpää S, Vihtonen K, Mero M, Laiho J, Törmälä P, et al. The effect of a penetrating biodegradable implant on the epiphyseal plate: An experimental study on growing rabbits with special regard to polyglactin 910. J Pediatr Orthop 1987;7:415-20.
15. Mäkelä EA, Vainionpää S, Vihtonen K, Mero M, Helevirta P, Törmälä P, et al. The effect of a penetrating biodegradable implant on the growth plate. An experimental study on growing rabbits with special reference to polydioxanone. Clin Orthop Relat Res 1989;241:300-8.
16. Stadelmaier DM, Arnoczky SP, Dodds J, Ross H. The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 1995;23:431-5.
17. Van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: A paradigm shift. Surgeon 2017;15:161-8.
18. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: Early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy 2015;31:2162-71.
19. Taylor SA, Khair MM, Roberts TR, DiFelice GS. Primary repair of the anterior cruciate ligament: A systematic review. Arthroscopy 2015;31:2233-47.
20. Vermeijden HD, van der List JP, O’Brien RJ, DiFelice GS. Primary repair of anterior cruciate ligament injuries: Current level of evidence of available techniques. JBJS Rev 2021;9:e20.00174.
21. Ferretti A. To heal or not to heal: The ACL dilemma. J Orthop Traumatol 2020;21:11.
22. van der List JP, Vermeijden HD, Sierevelt IN, DiFelice GS, van Noort A, Kerkhoffs GM. Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is needed: A systematic review and meta-analysis of recent literature. Knee Surg Sports Traumatol Arthrosc 2020;28:1946-57.
23. Nwachukwu BU, Patel BH, Lu Y, Allen AA, Williams RJ 3rd. Anterior cruciate ligament repair outcomes: An updated systematic review of recent literature. Arthroscopy 2019;35:2233-47.
24. Kandhari V, Vieira TD, Ouanezar H, Praz C, Rosenstiel N, Pioger C, et al. Clinical outcomes of arthroscopic primary anterior cruciate ligament repair: A systematic review from the scientific anterior cruciate ligament network international study group. Arthroscopy 2020;36:594-612.
25. Van der List JP, Mintz DN, DiFelice GS. The locations of anterior cruciate ligament tears in pediatric and adolescent patients: A magnetic resonance study. J Pediatr Orthop 2019;39:441-8.
26. Christino MA, Tepolt FA, Sugimoto D, Micheli LJ, Kocher MS. Revision ACL reconstruction in children and adolescents. J Pediatr Orthop 2020;40:129-34.
27. Thorolfsson B, Svantesson E, Snaebjornsson T, Sansone M, Karlsson J, Samuelsson K, et al. Adolescents have twice the revision rate of young adults after ACL reconstruction with hamstring tendon autograft: A study from the Swedish National Knee Ligament Registry. Orthop J Sports Med 2021;9:23259671211038893.

How to Cite this article: Arora M, Weitz F. Physeal Sparing ACL Repair using Knotless Suture Anchor Technique for Pediatric ACL Injuries. Journal of Clinical Orthopaedics January-June 2025;10(1):57-60.

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