Modified MacIntosh (Over-the-Top Iliotibial Band Autograft) Technique for Pediatric Anterior Cruciate Ligament Reconstruction Using Knotless All-Suture Anchor Fixation

Anterior cruciate ligament (ACL) injury is a significant cause of injury among pediatric patients with an increasing incidence. ACL insufficiency can lead to lifelong disability as further joint deterioration occurs in the form of meniscal and subsequently chondral pathology. Techniques for pediatric ACL reconstruction can broadly be classified as physeal-sparing and non–physeal-sparing. Bone age is frequently used when deciding which technique to employ. Patients are candidates for physeal-sparing, over-the-top iliotibial band reconstruction (i.e., modified MacIntosh II) when they have >4 years remaining before skeletal maturity. The modified Macintosh procedure provides both intra- and extra-articular rotational and translational constraint. This Technical Note describes the senior author’s modified MacIntosh technique using knotless all-suture anchor fixation in a suture staple technique to mitigate risk of physeal damage.