Modification of the Micheli-Kocher Technique with Anterior Cruciate Ligament Remnant Preservation and Augmentation in Pediatric Patients: A Technical Note
Abstract
Objective: To describe a modification of the Micheli-Kocher technique that incorporates anterior cruciate ligament (ACL) remnant preservation and augmentation to enhance biological potential in skeletally immature patients. Materials and Methods: The surgical procedure is described in an 8-year-old boy (Tanner stage I) who competes in motocross. The key modification involves using an arthroscopic shaver to create an oblique opening in the superolateral portion of the remnant, through which the iliotibial band graft is passed. This allows the remnant tissue to provide biological support and guide the neoligament. Results: At the 12-month follow-up, the patient’s knee was clinically stable (negative Lachman and pivot-shift tests), and radiographs showed no limb length discrepancies or angular deformities. He successfully returned to high-impact competitive sport (motocross), with marked proprioceptive recovery and full range of motion. Conclusions: This technical modification combines the mechanical safety of extraphyseal reconstruction with the potential biological benefits of remnant preservation. The technique was a safe alternative in this single case; however, studies with a higher level of evidence are needed to confirm its comparative advantages in ligamentization and proprioception.Downloads
References
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