Technique development
FDA clearance of the first ACL reconstruction device made for children
The implant Dr. Green helped evaluate, and the pediatric instrumentation he helped design.
What it found
- The FDA cleared the ACL TightRope II implant for reconstructing a torn ACL in children and adolescents — the first device cleared for that age group.
- Before it, only adult instrumentation guides existed, and they are not suited to operating around a growing skeleton.
- The all-epiphyseal technique drills sockets rather than tunnels, working around the growth plate, and is used in the youngest athletes with more than three years of growth remaining.
- A complete transphyseal technique with a quadriceps autograft is used instead as an athlete approaches skeletal maturity.
- The cleared implant uses an adjustable rather than fixed loop, so the graft can be tensioned on the operating table.
Cleared by the U.S. Food and Drug Administration, announced January 2023.
In Dr. Green’s own words
The ideal patient for the procedure is, in general, a child between the ages of 12 and 15 to 16, depending upon the athletes’ skeletal maturity, at which point the growth plates are effectively closed,
HSS Newsroom · 10 January 2023. Dr. Green and Frank A. Cordasco, MD, MS, developed the all-epiphyseal technique together and designed the pediatric and young-adolescent instrumentation guides for it. Their collaboration with the manufacturer began roughly 15 years before the clearance. Read the original
The research behind it
The 6 most recent of his 12 papers on ACL reconstruction in the growing knee, indexed on PubMed under his Hospital for Special Surgery affiliation. Each opens on PubMed.
All 12 of his papers on this subject- Validation of the ACL Return to Sport after Injury (ACL-RSI) Scale in Pediatric and Adolescent Patients After Medial Patellofemoral Ligament Reconstruction Orthopaedic journal of sports medicine · 2026 May · Dr. Green is author 10 of 11
- Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Prospective Multicenter PLUTO Study The American journal of sports medicine · 2025 Mar · Dr. Green is author 12 of 25
- Association of Lateral Extra-Articular Tenodesis With Improved Graft Maturity on MRI 2 Years After ACL Reconstruction With Quadriceps Tendon Autograft in Skeletally Immature Athletes Orthopaedic journal of sports medicine · 2024 Jan · Dr. Green is author 5 of 5
- Validation of the ACL-RSI Scale in Pediatric and Adolescent Patients The American journal of sports medicine · 2023 Oct · Dr. Green is author 6 of 7
- Anterior Cruciate Ligament Reconstruction in Skeletally Immature Athletes Using All-Epiphyseal Techniques Clinics in sports medicine · 2022 Oct · Dr. Green is author 4 of 4
- Improved epiphyseal socket placement with intraoperative 3D fluoroscopy: a consecutive series of pediatric all-epiphyseal anterior cruciate ligament reconstruction Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022 Jun · Dr. Green is author 4 of 4