All-Inside Partial Epiphyseal Anterior Cruciate Ligament Reconstruction Plus an Associated Modified Lemaire Procedure Sutured to the Femoral Button

Anterior cruciate ligament (ACL) tears in skeletally immature patients are on the rise; pediatric athletes are now in constant year-round sports participation. Nonoperative treatment may lead to poor functional outcomes and an increase in associated intra-articular lesions and sometimes can cause drop-out from sports activity. The treatment of these injuries is not at all clear, and appropriate guidelines do not exist. Physeal-sparing and partial physeal-sparing techniques have been described. Concerns about restoring normal knee kinematics with the previously described ACL reconstruction (ACLR) techniques are open to debate. We describe a partial epiphyseal ACLR to be done in skeletally immature patients involved in highly demanding sport activities. This technique is performed with an extraphyseal femoral tunnel drilled retrograde, a transphyseal tibial tunnel, and a retrograde tibial drilling without trespassing the tibial physis. We added a modified Lemaire procedure to improve rotational instability to the previously performed ACLR.