Extraphyseal Anterior Cruciate Ligament Reconstruction and Lateral Tenodesis Using Hamstrings for Prepubescent Patients: The WHAT Technique (Without Hardware And Tunnels)

Anterior cruciate ligament injuries in prepubescent skeletally immature patients with significant remaining growth pose a serious challenge as surgeons must balance the desire to restore stability to the knee and prevent meniscal and chondral damage with the risk of iatrogenic injury to the open tibial and femoral physes. A physeal-sparing intra- and extra-articular reconstruction, which is a modification of a long-used “over-the-top and lateral extra-articular tenodesis” technique, is proposed as a safe approach to treat these patients. This article reports on the surgical details of this technique.