Paediatric ACL repair reinforced with temporary internal bracing

Knee Surg Sports Traumatol Arthrosc. 2016 Jun;24(6):1845-51. doi: 10.1007/s00167-016-4150-x. Epub 2016 May 3.


Purpose: Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children.

Methods: Two patients (aged 5 and 6 years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace that was removed after 3 months.

Results: Second-look arthroscopy, examination and imaging at 3 months confirmed knee stability and complete ACL healing in all cases. Normal activities were resumed at 4 months, and excellent objective measures of function, without limb growth disturbance, were noted beyond 2 years.

Conclusion: ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair.

Level of evidence: IV.

Keywords: ACL repair; Internal bracing; Paediatric ACL.

Publication types

  • Case Reports

MeSH terms

  • Anterior Cruciate Ligament Injuries / diagnostic imaging
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Arthroscopy / methods
  • Braces
  • Child
  • Female
  • Growth Plate
  • Humans
  • Knee Joint / surgery
  • Magnetic Resonance Imaging
  • Male
  • Second-Look Surgery
  • Tibia / surgery
  • Tibial Fractures / surgery