Minimally Invasive Ligament Construction in Children

Anterior Cruciate Ligament injuries are becoming increasingly common in the young active individual. MRI has also contributed significantly to the early diagnosis of these injuries. Treatment of ACL (Anterior Cruciate Ligament) injuries in the child and young adolescent remains controversial. This is especially so in the case of small children whose skeletons are yet to mature.

Any treatment plan must consider an assessment of the patients’ physical maturity, level of functional instability and identification of associated injuries. While a trial of non operative treatment may still be upheld by some, most reports of non operative treatment have demonstrated poor results. The natural history of the ACL deficient knee is one of recurrent episodes of giving way with resultant multiple meniscal tears and early degenerative arthritis.

Arthroscopic Reconstruction Transphseal Hamstring Graft

Arthroscopic ACL reconstruction is an elegant solution to this problem.Physeal sparing techniques have yielded poor results and therefore transphyseal techniques is one of the best solution to the problem.

The Hamstring tendon graft using semi tendinosus and Gracilis tendons or quadruped semi tendinosis graft provides an exceptionally strong and reliable graft. It has the added benefit of being harvested through a small unobtrusive incision. There is no post operative morbidity (as with B.T.B. graft) and the tendons grow back in time.

A quadrupled hamsting tendon provides 250% strength of the normal A.C.L. The most contemporary concept of double bundle grafting can only be affected with Hamstring tendon grafting.

Graft Fixation

Graft selection is the corner stone upon which optimal intra-articular ACL reconstruction is built; however graft fixation is important to allow early aggressive rehabilitation post operatively. Excellent initial graft fixation strength is essential for good graft tunnel bonding and therefore contributes immensely to the final outcome of this surgery. The first weeks are especially critical.

At the WOCKHARDT KNEE CLINIC we have been using the BIOTRANSFIX system for Femoral tunnel fixation with Bio-interference screw for tibial fixation with excellent results in 77 patients so far. The procedure is especially safe for young children who have significant growth left.


Dr. Gautaum Kodikal, M.S.
Consultant Orthopedic Surgeon
Department of Bone & Joint Care
Wockhardt Hospitals, Bangalore