Summary
Using living donor HT for ACL R in pediatric population does not determine changes in the degree of integration or maturation of the graft
Abstract
Objective
To assess whether using a living donor hamstring graft for anterior cruciate ligament reconstruction (ACLR) in paediatric patients determines an alteration in the maturation and/or integration of the graft when assessed by magnetic resonance imaging (MRI) in comparison to autologous hamstring (HT) grafts .
Methods
A series of paediatric patients undergoing ACL R with HT were prospectively evaluated. Group 1 included 15 patients that underwent ACL R with autologous HT tendons. Group 2, included 15 patients in whom the HT used for reconstruction were donated by one of the two parents. In both groups, MRI was performed 12 months postoperatively, calculating three parameters: a) the SNQ (Signal to Noise Quotient) that reflects the mechanical resistance of the graft (the main endpoint). b) the graft healing (signal intensity at the bone-graft interface) measured by the use of the scale described by Ge et al., and the maturation of the tendons in the tibial tunnel using the Howell scale (secondary outcomes). All measurements were performed by 2 observers, each performing the measurement 2 times to analyze inter and intra-rate reliability.
Results
The mean SNQ in group 1 was 6.38 ± 2.78 (range 4.58-7.01), while in group 2 it was 5.96 ± 3.29 (range 4.88-6.79) without significant differences (p=0.84). In terms of graft healing (Ge scale) there was no significant difference in the population distribution based on the signal intensity between the 2 groups (p=0.63). Also for the evaluation of the graft maturity (Howell scale), no significant differences were detected between the 2 groups (p= 0.78). Finally, no significant intra- or inter-observer differences were seen.
Conclusions
Using living donor HT for ACL reconstruction in pediatric patients does not determine changes in the degree of integration or maturation of the graft when assessed by MRI at one year of postoperative follow-up compared to autologous hamstring tendons. The current is the first radiological study carried out for assessing living donor HT in pediatric ACL R and suggests that the integration of the living donor graft is not different when compared with autologous HT tendons.