Editorial Commentary: The All-Epiphyseal Anterior Cruciate Ligament Distal Femoral Approach: Sockets or Tunnels? Editorial Article uri icon

Overview

abstract

  • I believe that the distal femoral approach for anterior cruciate ligament reconstruction in the skeletally immature athlete with 3 to 6 years of remaining growth is best performed with an all-inside, all-epiphyseal technique using sockets rather than an outside-in approach creating tunnels. A shorter socket rather than a longer tunnel exposes a smaller surface area of the lateral distal femoral physis to potential compromise and resultant valgus malalignment. In addition, exiting the lateral femoral aspect of the epiphysis with a full-diameter tunnel as compared with a smaller diameter drill hole used to prepare a socket places the posterior articular cartilage, the lateral collateral ligament and anterolateral ligament footprints, and the popliteus tendon insertion at risk. My preference for sockets is also related to my belief that they provide a superior biologic milieu for graft incorporation compared with a full-length tunnel with the attendant violation of the lateral femoral cortex of the epiphysis.

publication date

  • May 1, 2018

Research

keywords

  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction
  • Lateral Ligament, Ankle

Identity

Scopus Document Identifier

  • 85046471927

Digital Object Identifier (DOI)

  • 10.1016/j.arthro.2018.02.020

PubMed ID

  • 29729762

Additional Document Info

volume

  • 34

issue

  • 5