Femoral Physeal Sparing/Transphyseal Tibial (Hybrid) Technique for ACL Reconstruction in Skeletally Immature Athletes

Several techniques exist for physeal sparing or physeal respecting ACL reconstruction in the growing population of skeletally immature patients with this injury. We describe a physeal sparing femoral tunnel placement with a transphyseal tibial tunnel, a hybrid ACL reconstruction technique, that can be used in skeletally immature patients with 2 years of growth remaining. It allows for a more anatomic femoral tunnel location within the footprint and minimizes potential physeal injury to the femoral physis. A vertical transphyseal tibial tunnel minimizes physeal injury and maximizes graft within the tibial tunnel. Future studies will be needed to examine the long-term effects of these procedures and compare their functional outcomes with other techniques for skeletally immature athletes.