Primary Anterior Cruciate Ligament Repair With Hyaluronic Scaffold and Autogenous Bone Marrow Aspirate Augmentation in Adolescents With Open Physes

It is well known that the anterior cruciate ligament (ACL) is the main stabilizer to the anterior tibial translation in the knee. The current gold standard of treatment for such lesions is ACL reconstruction. However, there are notable disadvantages to ACL reconstruction that include loss of proprioception, donor site morbidity, incomplete return to high-demand sports, and the inability to restore normal kinematics of the knee joint. Additionally, in adolescents who have open physes, there is a risk of potential iatrogenic growth plate injury. Tibial-sided soft-tissue avulsion is a rare subtype of ACL injuries. This Technical Note presents a method for primary anatomic ACL repair with a bioabsorbable scaffold and bone marrow concentrate augmentation for an acute distal ACL injury. Our technique is an alternative to reconstruction as it allows the preservation of the native insertion site and has the potential to reduce the risk of posttraumatic osteoarthritis.