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Background: The incidence of anterior cruciate ligament (ACL) tear in the skeletally immature pediatric population has been steadily increasing due to multiple factors, including multiple sports participation, year-round training, and the increase in the number of athletes. Reconstruction in these patients is challenging due to the open physes at the distal femur, proximal tibia, and tibial tuberosity apophysis. Violation of the physis can result in angular deformities or leg length discrepancies. Indications: To demonstrate steps of all epiphyseal ACL reconstruction in skeletally immature patients using quadriceps tendon autograft. Technique Description: After the patient is positioned, prepped, and draped, the quadriceps tendon autograft is harvested and prepared to be used as the autograft. Using the all-inside technique, femoral and tibial tunnels are created as all-epiphyseal to prevent violating the physes. The ends of the graft are then passed through the tunnels and fixed with an adjustable loop on the femur and a button on the tibia. Results: Although excellent clinical outcomes and a high return to sports rates have been reported after ACL reconstruction, the technique to be chosen is not clear yet. Discussion/Conclusion: Quadriceps tendon autograft provides an excellent alternative as a graft choice in skeletally immature patients.

Purpose: To identify a comprehensive list of outcome measures previously used in the literature to evaluate clinical outcomes after reconstruction of the anterior cruciate ligament (ACL) in patients 18 years of age or younger. Methods: A literature search was performed by querying MEDLINE, Embase and Cochrane computerized databases for relevant articles that reported clinical outcomes in pediatric patients undergoing ACL reconstruction. Studies that were nonclinical, that reported on patients older than 19 years, that were not available in English, or that included fewer than 10 patients were excluded. Outcome measures of all eligible studies were recorded. Results: We identified 77 studies published between 1986 and 2018 in 20 peer-reviewed journals. The mean age of the patients was 13.9 years. The ACL rerupture rate was reported in 60% of studies; 32 studies (42%) reported a rate of return to preinjury activity or sports. The use of adult-validated patient-reported outcome measures were reported in 63 (82%) articles. The Lysholm (64%), International Knee Documentation Committee (IKDC) (56%) and Tegner (37%) scores were the most commonly reported. Two patient-reported outcome measures designed for pediatric patients (the Pedi-IKDC and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS) were employed in 5 (6%) recent studies. Conclusions: There is variability across studies in the metrics used to assess clinical outcomes following ACL reconstruction in children and adolescents. Validated pediatric-specific instruments were used infrequently. Clinical Relevance: A large body of existing pediatric ACL-reconstruction literature relies on a variable set of outcome measures that have not been developed or validated for children and adolescents. More recently, contemporary studies have begun to employ pediatric- and adolescent-specific validated measures, yet their use remains uncommon.