Summary
Quadriceps tendon autograft for ACL reconstruction led to similar clinical outcomes, revision rates, and sports participation compared to hamstring in pediatric and adolescent patients.
Abstract
Background
Traditionally, hamstring graft (HT) is the most commonly used graft for anterior cruciate ligament reconstruction (ACLR) in the pediatric and adolescent patients aged = 18 years, but recently the STABILITY 1 trial and other studies may cast doubt on using HT autograft (in isolation) for at-risk athletes. On the other hand, quadriceps tendon (QT) autograft is gaining popularity for ACLR because QT autograft is associated with lower donor site morbidity, lower failure rate, greater mean cross-sectional area, and greater load to failure compared to HT autograft. However, there is no consensus regarding the graft choice for ACLR in these young patients.
Purpose
The purpose of this study was to compare the outcomes of HT and QT autografts for ACLR in pediatric and adolescent patients (age = 18 years) in terms of patient-reported functional outcomes (PROMs), knee stability, graft failure rates and sports participation after ACLR. The hypothesis was that QT autograft would result in better functional outcomes with a good rate of return to sporting activity and low graft failure after ACLR compared to HT autograft in pediatric and adolescent patients.
Methods
From 2010 to 2022, 2417 ACLR were performed. The inclusion criteria were primary ACLR using HT and QT autograft, age = 18 years. The exclusion criteria were revision ACLR, utilization of graft tissue other than HT and QT autograft, concomitant posterior cruciate ligament (PCL) injuries, and contralateral knee injuries. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up for Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; knee stability (Lachman and pivot shift test); graft failure and sports participation. Lachman test and pivot shift test were recorded pre-operatively under anesthesia and post-operatively at a 2-year follow-up.
Results
The number of patients in the HT and QT groups was 77 and 80 respectively. The two groups did not differ significantly in terms of age, gender and concomitant injuries. No significant difference was found in the pre-injury PROMs (Lysholm, Tegner activity level and VAS for pain) and knee stability between the two groups (p>0.05). Similarly, no significant difference was observed at 2 years of follow-up between the two groups for PROMs and knee stability (p>0.05). Lysholm knee score, Tegner activity level and VAS for pain score improved to pre-injury level in both the groups and no significant difference was found between pre-injury and 2-year follow-up for Lysholm, Tegner and VAS scores (p>0.05). At a 2-year follow-up both the groups achieved pre-injury level sports participation (p>0.05). Graft failure occurred in 11 (14%) and 8 (10%) patients of the HT and QT groups respectively. The rate of failure did not differ significantly between groups (p>0.05).
Conclusion
Quadriceps tendon autograft for ACL reconstruction led to similar clinical outcomes, revision rates, and sports participation compared to hamstring in pediatric and adolescent patients.
Level of evidence
Level II