Purpose

The aim of this study is to evaluate 2-year clinical and patient-reported functional outcomes of primary anterior cruciate ligament reconstruction (ACLR) with soft tissue quadriceps tendon autograft in skeletally immature patients.

Methods

Consecutive skeletally immature patients who underwent ACLR with quadriceps tendon autograft were included. All cases utilized full thickness soft tissue quadriceps autograft without a bone plug and were performed on patients with open growth plates. Preoperative demographic and surgical data were collected. The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal (AE) and complete transphyseal (CT). Patients were followed for a minimum of 24 months. Information regarding the return to sports and concomitant or subsequent surgical procedures was collected. KT-1000 was performed post-operatively, and Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject at their 2-year follow-up appointment.

Results

The final cohort included of 59 consecutive adolescent patients aged 11.1 to 18.6 (13.96 ±1.33) with a minimum follow-up of 2 years. One patient was lost to follow-up. Prior to surgery, 78% of patients reported playing team sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. 20 (34%) patients underwent AE and 38 (66%) underwent CT ACLR. Additionally, 33 (56.9%) underwent a lateral extra-articular tenodesis procedure using the iliotibial band (ITB) with a modified Lemaire technique, and 4 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum, both procedures were performed for non-modifiable risk factors as previously published for hamstring autograft ACLR. The rate of graft failure was 0%, and 10 patients had additional surgical procedures, of which 4 were concomitant removal of hardware for hemi-epiphysiodesis, 4 were contralateral ACLR, 2 were meniscal injuries that required surgical intervention and 1 was a lysis of adhesions. The mean KT-1000 at 2-year follow-up was -0.364 ±0.745. The median Pedi-IKDC score was 91, and the median HSS Pedi-FABS score was 27. At 2 years after surgery, 94.8% patients reported returning to sports.

Conclusion

This study reveals that quadricep tendon autograft ACLR had a low failure rate when compared to previously reported studies of ACLR with hamstring autograft. Based on these results, we recommend this technique for skeletally immature patients undergoing ACLR.