Page 45 - ISAKOS 2020 Newsletter Volume 2

However, there continues to be a stark lack of high-quality evidence in the skeletally immature ACL population, particularly with respect to graft choice. To date, the use of the QT as an autograft option for primary pediatric ACL reconstruction has not been well studied. Recent case series of pediatric patients who have been managed with a QT autograft for ACL reconstruction are promising. However, until recently, no RCT has endeavoured to examine the efficacy of the QT autograft for primary ACL reconstruction in pediatric patients.
Investigators at McMaster University are steering recruitment efforts for the pilot Soft-tissue Quadriceps Autograft ACL- reconstruction in the Skeletally-immature versus Hamstrings (SQuASH) study. That effort aims to demonstrate the feasibility of a global RCT that will evaluate the efficacy of all- soft-tissue QT versus HT autografts in terms of reoperation, return to sport, and knee function among pediatric patients managed surgically for ACL insufficiency.
In summary, the field of ACL reconstruction, as we know it, is changing. There is re-emerging clinical evidence to support the broader adoption and integration of the QT in the setting of primary ACL reconstruction. However, higher-quality studies are a fundamental step to arrive at widespread implementation and to evaluate long-term efficacy. We currently offer the QT as an option for all patient populations undergoing ACL reconstruction, regardless of age, activity status, sex, body habitus, or setting. We eagerly anticipate the findings from such focused groups as the International Quadriceps Tendon Interest Group, and perhaps with more evidence, we can collectively improve our decision- making algorithms.
References
1. Slone HS, Xerogeanes JW (2014). Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft: A Minimally Invasive Harvest Technique. JBJS Essent Surg Tech. 27;4(3):e16. 2. Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, Hoser C. International Quadriceps Tendon Interest Group. Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med. 2018 Jun; 52(11):698-701. 3. Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E (2019) Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta- analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone- Patellar Tendon-Bone and Hamstring-Tendon Autografts. Am J Sports Med United States 47:3531–3540. 4. Lind M, Strauss MJ, Nielsen T, Engebretsen L. Quadriceps tendon autograft for anterior cruciate ligament reconstruction is associated with high revision rates: results from the Danish Knee Ligament Registry. Knee Surg Sports Traumatol Arthrosc. 2019 Oct 22. doi: 10.1007/s00167-019-05751-5. 5. Lind M, Nielsen TG, Soerensen OG, Mygind-Klavsen B, Fauno P. Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomized controlled trial. Br J Sports Med. 2020 Feb; 54(3): 183-187.
CURRENT CONCEPTS
ISAKOS NEWSLETTER 2020: VOLUME II 43