AANA/SOMOS Enduring Knee Program 2025-Pediatric AC-PCL-PLC Surgery Plan

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The document details a comprehensive surgical procedure for reconstructing the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral corner (PLC) of the knee, including graft choices, positioning, and step-by-step surgical techniques.<br /><br />Grafts used include a 5-strand hamstring autograft for the ACL with various FiberWire and Tiger Loop sutures; a 10mm fresh frozen Achilles tendon allograft for the PCL with FiberLoop and FiberWire sutures and a bone plug; and a fresh frozen semitendinosus allograft for the PLC, prepared with FiberLoops.<br /><br />The patient is positioned for standard knee arthroscopy with foot drop and leg well padded in a leg holder. First, hamstring tendons are harvested and prepped. Arthroscopy portals are established high and tight laterally and low and tight medially; meniscal repair and debridement of torn ACL and PCL tissue are done. Complex instrumentation including a 70-degree scope, needle dilators, cannulas, and specialized drill sets are employed.<br /><br />Precise femoral and tibial tunnels for the ACL and PCL grafts are drilled using a combination of flip cutters, reamers, and guidewires, with attention paid to preserving growth plates during tunnel placement.<br /><br />Lateral knee exposure involves careful dissection of skin flaps, IT band, peroneal nerve, and fibular windows to access important anatomic structures including the fibular collateral ligament (FCL), popliteus tendon, and associated tunnels. Graft shuttling and fixation utilize biocomposite interference screws, cortical buttons, and suture anchors with tensioning boots used to properly tension PCL and ACL grafts through cycling maneuvers.<br /><br />The PLC reconstruction includes fixing the semitendinosus graft in fibular and popliteal tunnels and securing FCL grafts with the knee positioned at 30 degrees flexion and slight valgus load. Postero-lateral capsular shifts and possible lateral extra-articular tenodesis are performed as needed.<br /><br />Closure includes layered suturing of the IT band and skin with various sutures and infiltration with ropivacaine for analgesia. Throughout the procedure, care is taken to avoid damage to growth plates and to ensure anatomic restoration and stability of reconstructed ligaments.

Asset Caption

Judd Robbins, M.D.

Keywords

ACL reconstruction

PCL reconstruction

posterolateral corner (PLC) reconstruction

hamstring autograft

Achilles tendon allograft

semitendinosus allograft

knee arthroscopy

femoral and tibial tunnel drilling

graft fixation techniques

postoperative knee stability