Physeal-respecting anterior cruciate ligament reconstruction in adolescents: Our surgical experience and clinical outcomes

Objectives: Anterior cruciate ligament (ACL) injuries in adolescents are increasing with sports participation, and management in open physes is challenging due to the risk of growth disturbances. This study aims to assess long-term outcomes of physeal-respecting ACL reconstruction using the Micheli–Kocher IT band autograft technique. Materials and Methods: This retrospective case series included 17 skeletally immature adolescents with open physes who underwent Micheli–Kocher physeal-sparing ACL reconstruction between 2015 and 2024. Functional outcomes at 6, 12, and 24 months were assessed using Tegner-Lysholm and subjective International Knee Documentation Committee (IKDC) scores with repeated measures analysis of variance and Tukey’s post hoc analysis. Results: The cohort included 15 males and 2 females (mean age: 12.8 ± 0.90 years). Tegner–Lysholm scores improved significantly from 48.5 ± 5.33 preoperatively to 63.7 ± 3.44 at 6 months, 80.6 ± 3.32 at 1 year, and 91.1 ± 2.63 at 2 years ( p < 0.001). Subjective IKDC scores also rose significantly from 54.1 ± 3.13 preoperatively to 64.0 ± 2.78 at 6 months, 73.8 ± 3.11 at 1 year, and 86.5 ± 3.06 at 2 years ( p < 0.001). All consecutive pairwise comparisons were significant ( p < 0.001). No growth disturbances (arrest, deformity, or limb-length discrepancy), graft failures, or revisions occurred. Conclusion: The physeal-respecting Micheli–Kocher technique using an iliotibial band autograft is a safe and effective option for pediatric and adolescent ACL tears, providing excellent knee stability and functional recovery without risking growth plate arrest.