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All-epiphyseal Semitendinosus PCL Reconstruction in a 10-year-old Child

Warme, Winston J. MD*; Mickelson, Dayne BS

Journal of Pediatric Orthopaedics: July-August 2010 - Volume 30 - Issue 5 - p 465-468
doi: 10.1097/BPO.0b013e3181df863b
Lower Extremity

Background Tears of the posterior cruciate ligament (PCL) in pediatric patients, especially avulsions from its tibial insertion, are not frequently encountered by physicians. However, with an increasing incidence of ligamentous injuries to the knee in skeletally immature patients, orthopaedic surgeons will more frequently need to decide how best to manage a PCL injury in children with open physes.

Methods A 10-year-old boy sustained an avulsion of the PCL from its tibial insertion site after a bicycle motocross racing accident. He required a PCL reconstruction after failed conservative treatment and an unsuccessful attempt at primary repair. This successful physeal sparing reconstruction was accomplished using a modified method of femoral tunnel placement in combination with the tibial inlay technique.

Results A magnetic resonance imaging was acquired 2 years postoperatively when physical examination demonstrated both legs of equal length, no varus or valgus deformity, and a normal posterior drawer examination. Four years after the reconstruction, he continues to bicycle motocross race while experiencing no further symptoms and complete restoration to his prior quality of life.

Conclusions The use of the tibial inlay technique together with the modified femoral tunnel location prevented transphyseal drilling while attaining a favorable anatomic placement of the graft while avoiding the “killer” turn associated with the transtibial approach.

Level of Evidence Level IV (Therapeutic Study).

*Department of Orthopaedics and Sport Medicine, University of Washington Medical Center

University of Washington School of Medicine, Seattle, WA

Reprint: Winston J. Warme, MD, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356500, Seattle, WA 98195-6500. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.