Surgical Management of Anterior Cruciate Ligament Rupture in Skeletally Immature Adolescents: A Bilateral Transphyseal All-Inside Technique With Patient-Specific Bone Tunnels and Semitendinosus Autograft.

In recent years, with the widespread participation in athletic activities, the incidence of anterior cruciate ligament (ACL) ruptures among adolescent populations has shown an increasing trend. Without timely intervention, this condition can lead to meniscal tears, accelerated articular cartilage wear, and early-onset osteoarthritis, severely compromising knee joint development and function. Due to the presence of open physis, standard ACL reconstruction techniques used in adults may jeopardize the physeal structure during tunnel preparation and graft placement, thereby interfering with normal lower limb growth and potentially resulting in limb length discrepancies or angular deformities. Therefore, this study adopts a personalized and precision treatment strategy, using preoperative magnetic resonance imaging (MRI) for systematic quantitative analysis of each patient's knee joint, combined with an all-inside transphyseal reconstruction technique. This approach aims to effectively restore ACL function while minimizing the risk of physeal injury. This image-based, patient-specific bone tunnel planning strategy is designed to protect the physeal integrity while addressing the biomechanical stability requirements of the knee, offering a safe and effective treatment option for adolescent patients.