Summary

Quadriceps tendon autograft for ACL reconstruction led to similar clinical outcomes, revision rates, and sports participation compared to hamstring autograft in pediatric and adolescent patients.

Abstract

Purpose

The purpose of this study was to compare the outcomes of hamstring graft (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in pediatric and adolescent patients (age ≤ 18 years) in terms of patient-reported functional outcomes (PROMs), knee stability, concomitant injuries, graft failure rates and sports participation after ACL reconstruction. Considering the different structural properties of QT autograft, we hypothesize that QT autograft would result in better functional outcomes with a good rate of return to sporting activity and low graft failure after ACL reconstruction compared to HT autograft in this population.

Methods

From 2010 to 2022, 2417 ACL reconstructions were performed. The inclusion criteria were primary ACL reconstruction using HT and QT autograft, age ≤ 18 years. The exclusion criteria were revision ACL reconstruction, utilization of graft tissue other than HT and QT autograft, concomitant posterior cruciate ligament (PCL) injuries, contralateral knee injuries and conditions that might interfere with the standard postoperative rehabilitation protocol. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up for Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; knee stability (Lachman and pivot shift test); concomitant injuries, graft failure and sports participation. Lachman test and pivot shift test were recorded pre-operatively under anesthesia and post-operatively at a 2-year follow-up.

Results

The number of patients in the HT and QT groups was 77 and 80 respectively. The two groups did not differ significantly in terms of age, gender and concomitant injuries. No significant difference was found in the pre-injury PROMs (Lysholm, Tegner activity level and VAS for pain) and knee stability between the two groups (p>0.05). Similarly, no significant difference was observed at 2 years of follow-up between the two groups for PROMs and knee stability (p>0.05). Lysholm knee score, Tegner activity level and VAS for pain score improved to pre-injury level in both the groups and no significant difference was found between pre-injury and 2-year follow-up for Lysholm, Tegner and VAS scores (p>0.05). At a 2-year follow-up both the groups achieved pre-injury level sports participation (p>0.05). Graft failure occurred in 11 (14%) and 8 (10%) patients of the HT and QT groups respectively. The rate of failure did not differ significantly between groups (p>0.05).

Conclusion

Quadriceps tendon autograft for ACL reconstruction led to similar clinical outcomes, revision rates, and sports participation compared to Hamstring in pediatric and adolescent patients.

Level of evidence
Level II

What is known about the subject: Conservative management of ACL injuries in the pediatric and adolescent patient population may result in persistent instability and this can predispose strongly to meniscal damage and cartilage degeneration. With the availability of better instrumentation and a better understanding of ACL reconstruction with advances in surgical techniques, ACL reconstructions have been performed in this age group with good results, with the restoration of anterior knee stability and resumption of pre-injury activity.

What this study adds to existing knowledge: Arthroscopic ACL reconstruction by using HT or QT autograft in pediatric and adolescent patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. Both HT and QT autograft are acceptable graft options in this age group.