All-epiphyseal ACL Repair in 6 year old boy – technical details

This is the story of a 6-year old boy, who ruptured his ACL skiing. His mother discusses the medical journey in the video above.

This video shows his examination-under-anaesthesia prior to surgery, demonstrating that the ACL is lax and loose.

ACL Repair technical details

This set of fluoroscopy images demonstrates drilling below the growth plate on the femur and above the growth plate on the tibia, just making a 2.4mm tunnel.

Here you can see via video the drilling being done in the femur, using fluoroscopy to show us hitting the target.

This clip (no sound) shows the internal brace being pulled in and reduced - the button pulls down onto the femur. As the video runs, you can see us pulling it in on the outer side of the thigh bone and down through the middle of the femur and down to the tibial side. And then you can see us loading the repair sutures that have gone through the ACL onto that button.

The internal brace is made up by a tightrope fixation device which is a metal button with a loop of nylon through which the Fibretape is looped. The combination of the tightrope button and the fibretape is the internal brace.

This clip (no sound) shows us then tying those repair sutures down .

Recent paper of relevance

Accepted for publication May 2022: Paediatric ACL repair reinforced with temporary internal bracing. JournalKnee Surgery, Sports Traumatology, Arthroscopy, 24(6), 1845-1851DOI10.1007/s00167-016-4150-x

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The long bones in a child differ from those in an adult, not only in their size but also in having a special 'growth plate', or physis, a few centimetres from the ends.

They resemble fractures or breaks, but they are normal in a growing child. The apparent gap that you see on X-ray is not a gap at all but is filled with cartilage, which does not show up on X-ray. Cells in this cartilage layer replicate and new substance is laid down around them, and eventually this growing end turns into bone.

Once growth is complete at the end of one's teens, the growth plate fuses as all the cartilage has turned to bone, and then only a fine line may be apparent on the X-ray.

In an adult, drilling through the fused growth plate will cause no harm, as the plate is already fused, but this is not the case in a child.​

The child will be monitored as he grows using standing long-leg X-rays, to determine any leg-length difference.

FOLLOW-UP April 2022
At 12 months he is fully stable. No pain and full function with no growth disturbance.

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