Summary
Outcomes of quad tendon grafts in physeal sparing ACL surgery
Abstract
Introduction
Substantial developments in physeal sparing surgical techniques for anterior cruciate ligament reconstruction (ACLR) have demonstrated safety and efficacy in treating the skeletally immature patient. However, outcomes using quadriceps tendon (QT) autograft in this population are unknown. This study evaluates return to sport (RTS) and reinjury rates in patients that underwent physeal sparing ACLR using QT autograft.
Methods
All patients that underwent primary physeal sparing ACLR using QT autograft by a single surgeon between 2011 and 2021 were asked to complete a follow-up survey regarding RTS and reinjury, including pre-injury competition level, ability to return to pre-injury level of competition, and subsequent ipsilateral/contralateral knee injury. The primary and secondary outcomes were RTS, and subsequent injury respectively.
Results
Thirty-four patients were identified and contacted, of which 26 (76.5%) (24 male, mean age: 12.4 years (range: 9.4 – 15.5)) completed the survey 5.7 years (range: 19.8 – 138.3 months) postoperatively. Of those, 18 (69.2%) were competitive middle/high school athletes. Twenty-four (92.3%) patients returned to the same level of unrestricted participation in sports at 10.6 months (range: 6-17). Five patients required subsequent ipsilateral knee surgery for ACL revision (n=2, 7.7%), meniscus injury (n=2, 7.7%), and symptomatic hardware (n=1, 3.8%) after an average of 4.4 years (range: 2.7-7.1). Three patients (11.5%) sustained a subsequent contralateral ACL injury, and one patient sustained a contralateral posterior cruciate ligament sprain.
Conclusion
Mid-term outcomes of patients treated with physeal sparing ACLR using QT autograft are promising, with a high level of return to sports, and relatively low graft retear rate compared to previous studies reporting on other graft choices. At a mid-term graft failure rate of 7.7%, the QT autograft proves to be a viable option in the young, skeletally immature athlete.