ACL reconstruction without bone tunnels

Abstract

A dramatic rise in youth competitive athletic activity and year-round training and competition, along with an increased awareness of ACL injuries in children, has led to a commensurate increase in the frequency of ACL tears in the skeletally immature. Recent understanding of the risks of nonoperative treatment and surgical delay has supported a trend toward early operative treatment. In prepubescent patients, unique anatomy and considerable remaining skeletal growth make physeal-respecting ACL reconstruction challenging. This is significantly more difficult in the smallest knees with congenital ACL absence. Herein we discuss the indications, surgical technique, aftercare, and clinical outcomes after ACL reconstruction without bone tunnels, using an iliotibial band autograft technique.