Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction for Pediatrics Animation

Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction for Pediatrics Animation

This animation demonstrates an ACL reconstruction on a pediatric patient. Pediatric patients are not finished growing yet, so the growth plates at the end of their bones are still open. This allows the bones to continue to grow in length, so they become taller.

Because the growth plates are still open, the sockets for the graph that will be used to reconstruct a new ACL need to be drilled around the growth plates to prevent damage and problems with bone growth. Here, we see a left knee that is bent to expose the inside of the knee joint.

First, a special guide is used to align the drill at the correct angle at the end of the thigh bone, or femur. To make the socket and the thigh bone, also called femoral drilling, a drill pin is inserted into the guide and tapped into the bone. The blade at the end of the drill flips out and is pulled back to create a socket in the thigh bone from the inside out. The drill is removed, and a blue and white suture is passed through the socket and put off to the side to be used later.

Next, a socket will be drilled into the shin bone or tibia, also called tibial drilling. The special guide is used to align the drill to make sure that it aims at the correct spot inside the knee, avoiding the growth plate. The drill pin is inserted into the guide and tapped into the bone. The blade at the end of the drill flips out again and is pulled back to create a socket in the shin bone from the inside out. The drill is removed, and a black suture is passed through the socket.

Both sutures are retrieved and are used to pass the ACL graft into the sockets. The blue and white suture is attached to the top of the graft and pulled through the socket in the thighbone. Applying tension to the white strands secures the graft and metal button in place. The black suture is then used to pass the other end of the graft through the socket in the shinbone. A metal button is placed on top of the sutures on the shinbone, and the knee is bent and straightened to check the tension of the graft. The knee is then fully straightened, and final tension is applied to the sutures to secure the graft and metal button in place. The ACL reconstruction is now complete.