Summary
At minimum two-year follow-up, adolescent athletes undergoing quad tendon ACL-R experienced significantly improved post-operative IKDC scores, high rates of RTS, and low rates of graft failure.
Abstract
Purpose
The purposes of this study were to report on outcomes following quadriceps tendon (QT) anterior cruciate ligament reconstruction (ACL-R) in adolescent athletes and to identify patient-related and surgeon-related factors that may influence failure rates following QT ACL-R.
Methods
All patients age 14-17 years old who underwent primary anatomic, transphyseal, single-bundle ACL-R with QT autograft between 2010 and 2021 with minimum two-year follow-up were included for analysis. Demographic and surgical data as well as pre-operative International Knee Documentation Committee (IKDC) and Marx activity scores were collected retrospectively. All patients were also contacted to assess post-operative patient-reported outcomes (PROs) including IKDC and Marx activity scores as well as return to sport (RTS) data. Outcomes of interest included rates of revision ACL-R and ipsilateral complications, contralateral ACL tears, difference in pre- and post-operative PROs, and rates of RTS. Age, sex, and graft diameter, were additionally compared between groups who required revision ACL-R versus those who did not.
Results
A total of 89 adolescent athletes (mean age: 16.2 ± 1.1 years, 64% female) were included for analysis at mean follow-up of 4.0 years. Post-operative IKDC scores were significantly higher than pre-operative scores (88.5 vs 37.5; p <0.001), whereas Marx activity scores decreased post-operatively (14.3 vs 12.2; p = 0.011). Successful RTS occurred in 80% of patients at a mean time of 9.7 ± 6.9 months, of which 85% of patients returned to the same or higher level of sport. The most common reasons for failure to RTS included lack of time (n=7, 70%) and fearing re-injury or lacking confidence in the operative knee (n=5, 50%). The overall revision ACL-R rate was 10% (n=9), and contralateral ACL tears occurred in 14% (n=12) patients. The most common ipsilateral complications were post-operative loss of range of motion (n=8, 9%), and subsequent meniscus tears (n=6, 13%). No statistically significant differences in age, sex, or graft diameter were observed between patients who underwent revision ACL-R and those who did not.
Conclusion
In this study, QT autograft is a viable option for primary ACL-R in adolescent athletes. At minimum two-year follow-up, adolescent athletes experienced significantly improved post-operative IKDC scores, high rates of RTS, and low rates of graft failure. Surgeons may utilize this information when identifying the optimal graft choice for adolescent athletes who have sustained ACL injury and wish to return to high level of sports activity.