Summary

Short term follow up reveals that the functional and clinical results of adolescent ACL reconstruction with allograft are comparable with autograft ones.

Abstract

Background

Nowadays most pediatric orthopedic physicians would strongly recommend surgical reconstruction for complete anterior cruciate ligament (ACL) tears in the skeletally immature patients but there is some controversy over the appropriate technique as well as graft choice in these cases. The purpose of this study is to evaluate the clinical results of allograft in immature ACL reconstruction with two different techniques and compare them with the results of ACL reconstruction in this group age using soft tissue autograft.

Methods

Between April 2006 and March 2012, all adolescent candidates for ACL reconstruction were included the study and categorized by the Tanner staging system. The patients with Tanner stage II III, means more than 1 year of growth remaining, underwent partial transphyseal ACL reconstruction and the patients with Tanner stage VI, means less than 1 year of growth remaining, underwent transphyseal ACL reconstruction. Then they were divided in two groups (autograft and allograft) based on graft source. The surgical technique and postoperative rehabilitation program were the same in two groups. After 24 months follow up, the patients were evaluated clinically and reassessed according to Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) and 2000 IKDC Subjective knee evaluation form. The radiographic evaluation included in the patients with obvious malalignment and shortening.

Results

Eighteen patients with semitendinosus autograft and 13 patients with tibialis posterior tendon allograft underwent ACL reconstruction. No patients of both groups reported obvious instability, giving way or locking of the knee. Pivot shift test was negative in all patients, but weekly positive Lachman test could be found in 6 cases (%0.46) of allograft group and 7 cases (%0.39) of autograft group. Mild valgus knee was found in one case of autograft group that underwent partial transphyseal ACL reconstruction. No additional treatment was needed, because the patient didn’t complain of pain, limping and functional disturbance
The achieved mean 2000 IKDC subjective score in allograft and autograft groups were 84.3 ± 3.2 and 85.6 ± 4.4 respectively. (P = 0.24). Median KOOS subscale Knee Related Quality of Life (KRQOL) at 2 years was 78 (allograft group) versus 75 (autograft group) (p= 0.34). Median 2-year KOOS subscale Sports and Recreation was 82 (allograft group) and 85 (autograft group) (p=0.11). No statistical significant difference could be found between the two groups.

Conclusion

Short term follow up reveals that the functional and clinical results of adolescent ACL reconstruction with allograft are comparable with autograft ones. A good selection with accurate performance of the reconstructive technique warrants ideal clinical outcome without growth disturbance.