Summary

The use of living donor graft for pediatric ACL reconstruction seems to provide good ACL integration and maturation

Abstract

Objectives: To assess whether using a living donor hamstring graft for anterior cruciate ligament (ACL) reconstruction in pediatric patients can determine an alteration in the maturation and integration of the graft when assessed by magnetic resonance imaging in comparison to autologous hamstring tendons (HT).

Methods

Pediatric patients undergoing ACL reconstruction with HT were prospectively evaluated. In group 1 were included 15 patients that underwent ACL reconstruction with autologous tendons. In group 2 were included 15 patients in whom the HT used for reconstruction were donated by one of the two
parents. In both groups, magnetic resonance imaging (MRI) was performed 12 months postoperatively, calculating three parameters: the main endpoint was the SNQ (Signal to Noise Quotient) that reflects the mechanical resistance of the graft. The secondary outcomes were the graft healing (signal intensity at
the bone-graft interface) measured by the use of the scale described by Ge et al. and the maturation of the tendons in the tibial tunnel using the Howell scale. All measurements were performed by 2 observers, each performing the measurement 2 times to analyze inter and intra-rate reliability.

Results

The mean SNQ in group 1 was 6.38 ± 2.78 (range 4.58-7.01) and in group 2 was 5.96 ± 3.29 (range 4.88-6.79) without significant differences (p=0.84). In terms of graft healing (Ge scale) there was no significant difference in the population distribution based on the signal intensity between the 2 groups (p=0.63)
Also for the evaluation of the graft maturity (Howell scale), no significant differences were detected between the 2 groups (p= 0.78). No significant intra- or inter-observer differences were detected.

Conclusions

Using living donor HT for ACL reconstruction in pediatric patients does not determine changes in the degree of integration or maturation of the graft when assessed by MRI at one year of postoperative follow-up compared to autologous hamstring tendons. The present is the first radiological study carried out for the assessing of living donor HT in pediatric ACL reconstruction and suggest that the integration of the living donor graft is not different from autologous HT tendons.