Bilateral Anterior Cruciate Ligament Reconstruction with All-Inside Technique for Adolescent: A Review of the Literature and Case Report.

Abstract

Simultaneous bilateral anterior cruciate ligament (ACL) ruptures are rare, especially in the pediatric population, with very limited evidence. We aimed to review the current literature and present a case study of an adolescent patient who underwent bilateral reconstruction with hamstrings autograft in a single-stage with a partial transphyseal "all-inside" technique. The limited evidence reports that the incidence of growth disturbance following ACL reconstruction in the skeletally immature is 2.6% with no significant difference between a partial transphyseal and an all-epiphyseal technique. Regarding graft choice in the skeletally immature, no significant difference has been found in function using hamstrings versus bone-to-bone patella autograft. The all-inside technique has shown good outcomes in the skeletally immature with no cases of growth disturbance observed in the literature reviewed. Patients spend less days in hospital and return to sport sooner following simultaneous reconstruction versus staged. A 15-year-old male footballer underwent simultaneous reconstruction of bilateral ACL ruptures through a partial transphyseal "all-inside" technique with hamstrings autografts. He began physiotherapy according to local protocol and was discharged from hospital on Day 4 post-operative. He returned to competitive sports 11 months postoperatively with no intraoperative or post-operative complications. This case suggests that bilateral simultaneous ACL reconstruction is a safe management strategy in the rare case of bilateral ruptures in the skeletally immature, which adds to the evidence base. The number of required hospital stays was reduced and there was return to sport in a comparative time frame to unilateral ACL reconstruction rehabilitation.