Late femoral button migration following autograft all-epiphyseal anterior cruciate ligament reconstruction in a skeletally immature child: a case report.

BACKGROUND: Late femoral button migration following an all-epiphyseal ACL reconstruction utilizing a semitendinosus autograft is uncommon. MATERIALS AND METHODS: We report a case of a 17-year-old male patient with bilateral anterior cruciate ligament (ACL) reconstructions using semitendinosus autografts who presented with late migration of the femoral button in the right knee nearly 5 years after the index procedure. RESULTS: A physeal-sparing, all-epiphyseal, all-inside technique with semitendinosus autograft and adjustable-loop suspensory fixation was utilized for the initial procedure. Subsequent radiographs and magnetic resonance imaging were obtained, demonstrating the late migration of the femoral button into the joint, as well as confirming the incorporation and integrity of the ACL graft. The femoral button was removed arthroscopically under general anesthesia. After removal of the femoral button from the right knee, the patient returned to pain-free activity and recovered full range of motion. CONCLUSIONS: This case report serves to highlight late failure of a pediatric all-epiphyseal ACLR technique with an intact graft. Surgeons utilizing all-epiphyseal techniques with adjustable-loop suspensory fixation in skeletally immature ACLR cases should be aware of this potential late complication.