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ACL repair in a 6 year old using the internal brace technique
ESSKA Academy. Wilson A. Sep 4, 2015; 113073
Prof. Dr. Adrian Wilson
Prof. Dr. Adrian Wilson
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This video demonstrates the internal brace technique in a 6 year old boy with a complete ACL rupture. The injury was sustained skiing. The young boy presented at 5 weeks post injury with an unstable knee from which he had symptomatic instability.
This is a difficult clinical problem to deal with and at present their are few good options. We could of course do a traditional ACL reconstruction but this would violate the growth plates and has a significant potential for growth disturbance. We could use an over the top position on the femur and an extraphyseal approach on the tibia.
Where the internal brace is not an option I personally think an excellent option is to use an all epiphyseal approach using the ALL inside technique.
I have now used the ACL repair technique in 8 skeletally immature patients which have included a 5 year old who now has 12 month scores. This little girl now has a normal clinical examination and has returned to normal function.
I have not yet had a failure in the skeletally immature group under my care.
If i did have a failure i would of course be able to go on and very easily carry out a formal ALL inside ACL reconstruction.
I believe it is essential to remove the hardware in these very young patients and do this as a routine.
It is my opinion that ACL repair represents an excellent option for the paediatric ACL deficient knee and will with time become the standard practice of care.
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