Physeal Sparing Posterior Cruciate Ligament Reconstruction in Paediatric Patients With Open Physes Using an Outside-In Femoral Tunnel and a Low Tibial Tunnel.

In recent years, with increasing participation of adolescents in sports activities, the incidence of posterior cruciate ligament (PCL) injuries in paediatric patients has been increasingly reported. Conventional PCL reconstruction techniques typically require drilling femoral and tibial tunnels that cross or are adjacent to the physes. In paediatric patients with open physes, this technique carries a risk of damage to the physes, growth arrest, and lower limb deformity. For patients with open physes, a PCL reconstruction technique that both avoids physeal injury and restores knee stability is of critical importance. We describe a PCL reconstruction technique in this technical note. On the femoral side, a retrograde outside-in drilling technique is employed to create the femoral tunnel distal to the physis. On the tibial side, using the meniscofemoral-like structure as a reference, a low tibial tunnel is recreated.