Complete Transphyseal Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature

Complete transphyseal reconstruction of the anterior cruciate ligament in prepubescent, skeletally immature patients must be done using a soft tissue hamstring autograft that spans or traverses the physes and with attention to the principles of tight tunnel fit, use of 0.5-mm incremental reamers with low speed and high torque, creation of a long, central tibial tunnel, avoidance of oblique femoral tunnels, and fixation proximal to the femoral physis and distal to the tibial physis. Reconstruction using these principles offers predictable outcomes of good stability and a high return to preinjury level of function with low risk for iatrogenic physeal injury.