All-Epiphyseal Anterior Cruciate Ligament Repair Using Suture Ring Device in the Skeletally Immature Patient

Anterior cruciate ligament (ACL) tears in pediatric patients pose distinct challenges in management, especially in patients with open distal femoral and proximal tibial physes. There are a variety of contemporary reconstruction techniques that attempt to address these challenges. However, with the resurgence of ACL repair in the adult population, it has become apparent that the pediatric patient may also benefit from primary ACL repair rather than reconstruction. ACL repair is a procedure performed to treat ACL tears that avoids the donor-site morbidity seen with ACL reconstruction using autograft. We describe a surgical technique involving FiberRing sutures (Arthrex, Naples, FL) and TightRope–internal brace fixation (Arthrex) for ACL repair with all-epiphyseal fixation in the pediatric patient. The FiberRing is a knotless, tensionable suture device that can be used to stitch the torn ACL and coupled with the TightRope and internal brace to fix the ACL.