2015 ISAKOS Biennial Congress ePoster #1346

An ACL Repair Using the Internal Brace Technique in a 5 Year Old Patient

Ioannis Pengas, MBChB, MRCS, MPhil, MD, FRCS (T&O), Truro, Cornwall UNITED KINGDOM
Breck R. Lord, MA, MBBS, PhD, FRCS, Sydney, New South Wales AUSTRALIA
Adrian J. Wilson, MBBS BSc FRCS, London UNITED KINGDOM

Basingstoke Hospital , Basingstoke, UNITED KINGDOM

FDA Status Not Applicable

Summary: a minimally invasive technique for repair of a ruptured ACL in a 5 y old patient



An ACL repair using the internal brace technique in a 5 year old patient.


ACL tears in paediatric patients with open physes are relatively uncommon but the incidence is increasing and represents a major challenge in terms of management. The treatment remains controversial and several different surgical techniques have been described for reconstruction.
Avoidance of surgery in fear of physeal injury leading to leg length discrepancy and angular deformity has lead to the use of non-operative measures in many instances. The concern is the secondary damage that frequently occurs with chondral and meniscal injury due to knee instability which can be devastating
We describe a case report of a 5 year old child who presented with a complete tear of the ACL. Rather than reconstruct the ACL we undertook a direct repair and internal brace.


The patient underwent the repair at 5 weeks. Direct repair was achieved by approximating the ACL remnant to the lateral wall of the femur. This was then supplemented by an “internal Brace”. The surgery was carried out all epiphyseal on the femoral side and trans-physeal on the tibial side using 3mm tunnels. The patient was allowed to fully weight bear at 4 weeks. A second look was undertaken at 3 months and the hardware removed.


At the second look the EUA revealed a normal clinical examination with a negative lachman and pivot shift. The arthroscopic findings were of a completely healed ACL. Three weeks post second look the child had returned to normal activities including running and jumping pain free with a stable knee.


We believe that in selected cases where there is a good ACL remnant direct repair should be undertaken as an alternative to conventional reconstructive surgery which requires prolonged rehabilitation and the risks of subsequent growth disturbance.