Arthroscopic All‐Epiphyseal Button and Anchor Technique Anterior Cruciate Ligament Repair With a Collagen‐Based Implant

We describe a modified technique for anterior cruciate ligament (ACL) repair in skeletally immature patients with the bridge‐enhanced ACL restoration (BEAR) implant (Miach Orthopaedics) utilizing an arthroscopic, all‐epiphyseal approach. This technique uses a button on the proximal tibial epiphysis and an extra‐articular knotless anchor on the lateral femoral epiphysis to hold the ACL repair sutures and ACL seatbelt sutures. The all‐epiphyseal approach is advantageous for BEAR in skeletally immature patients, preserving the physis and minimizing potential complications. Additionally, this technique facilitates delivery of the BEAR implant by blunt tip syringe under arthroscopic guidance, eliminating the anteromedial arthrotomy for manual implant insertion.