Background: The “all-inside” technique is a recent approach that aims to minimize surgical trauma and improve graft placement in anterior cruciate ligament (ACL) reconstruction. Pediatric patients require a different surgical approach than adults since they still have growth plates and are at risk of epiphyseal damage and growth arrest during surgery. This case report aimed to report all-inside ACL reconstruction in a skeletally immature patient. Presentation of Case: A 13-year-old boy presented with a painful left knee since falling at school six months ago. Physical examination of the left knee revealed joint instability, limited range of motion, and a positive Lachman test. Magnetic Resonance Imaging (MRI) showed an ACL tear. We then performed an arthroscopic all-inside ACL reconstruction using a hamstring autograft. Sockets were created in the femur and tibia using specialized instruments, and the graft was secured within these sockets using suspensory fixation devices. No bone tunnels were drilled through the full thickness of the bone. After the surgery, the patient felt no more pain in his left knee and was more stable when standing. He was able to resume his daily activities at school without pain. Discussion: The advantages of an all-inside approach in skeletally immature patients compared to traditional outside-in techniques are smaller incisions, reduced surgical dissection, less pain, quicker recovery, preserved bone stock, reduced complication risk, and facilitated anatomic graft placement. Conclusion: The all-inside ACL reconstruction technique using hamstring grafts can be performed successfully in a skeletally immature patient.
Tutuko et al. (Mon,) studied this question.