The incidence of anterior cruciate ligament (ACL) injuries in the pediatric population is increasing. While nonoperative management was historically favored, delayed surgery is associated with secondary intra-articular injuries. For skeletally immature patients, physeal-sparing techniques, such as the modified MacIntosh iliotibial band (ITB) autograft, provide joint stability without risking physeal arrest. A 13-year-old male presented with left knee pain and instability 10 days after a twisting injury. Imaging and arthroscopy confirmed a complete ACL tear. The patient underwent a physeal-sparing ACL reconstruction utilizing an ITB autograft, which was secured to the tibial epiphysis with a knotless anchor. The modified MacIntosh technique with epiphyseal knotless anchor fixation is a biomechanically sound solution for pediatric ACL ruptures. It restores knee stability while preserving growth potential.
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Mishra et al. (2026) studied this question.
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