ACL reconstruction in adolescent athletes. Hamstring vs quadriceps tendon tendon autografts. Early outcomes of a prospective study

Abstract

Introduction Recently increased numbers of anterior cruciate ligament (ACL) injuries are seen in adolescent population. Mostly that is due to better diagnostic abilities and constant rise of involvement in specialized sports activities. There is no more discussion whether ACL in young patient should be reconstructed. It is proven that ACL reconstruction (ACLR) prevents further meniscus and cartilage damage. Graft choice for ACLR is an important debate. Traditionally hamstring (HS) tendons are more commonly used for ACLR. Another option trending is quadriceps tendon (QT) autograft. Some data claims that QT autograft is excellent and robust tissue which is relatively easy to harvest and provides great knee stability. Aims and Objectives To evaluate and compare knee stability (side-to-side anterior tibial translation) after ACLR using HS versus QT autograft in adolescents. Materials and methods A prospective randomised study of 50 (29 male, 21 female) patients from 13 to 17 years old who suffered ACL tear and were treated at Hospital of LUHS Kaunas Clinics. Diagnosis of ACL tear must have been confirmed clinically and on MRI. Treatment method was randomly chosen. For group I (n = 27) HS graft and for group II (n = 23) QT graft was used for ACLR. Before the surgery IKDC questionnaire and Tegner Lysholm knee scoring scale were filled by the patients. During the surgery data of meniscal damage and graft diameter were collected. Genourob (GNRB) knee arthrometer was used 3, 6 and 12 months postoperatively to evaluate side-to-side anterior tibial translation. At the moment GNRB data of 3 (GNRB1) and 6 (GNRB2) months postoperatively were compared. Force of 134N was used in GNRB1 testing and forces of 134N, 150N and 200N were used in GNRB2 testing. Data analysis was performed by IBM SPSS 27 software. Data is presented using descriptive statistics. For data comparison between methods Mann Whitney U test was used. Results Mean age of the patient at the time of the surgery was 15.96 (SD 1.26). Average IKDC score before the surgery was 54.42 (SD 18.01), average Lysholm score was 68.59 (SD 21.03) and Tegner activity level score averaged at 7.51 (median 9). Associated meniscal lesion was found in 37 patients (74 %). 18 patients (36 %) suffered medial, 12 (24 %) had lateral and 7 (14 %) had both ruptured meniscus. Depending on graft choice 27 patients (54 %) formed HS group and 23 (46 %) formed QT group. GNRB1 was performed on 34 patients (68 %) and GNRB2 on 30 patients (60 %). There was no significant difference in graft diameter between HS group 9.19 mm (SD 1.01) and QT group 9.44 mm (SD 0.46) (U = 217, p = 0.064). Smaller but not significantly different side-to-side anterior tibial translation was seen in QT group vs HS group during GNRB1 and GNRB2 testing at 134N force: QT group GNRB1 0.97 mm (SD 0.79) vs HS group GNRB1 1.67 mm (SD 1.52) (U = 60.5, p = 0.092); QT group GNRB2 1.21 mm (SD 0.96) vs HS group GNRB2 1.59 mm (SD 1.38) (U = 105, p = 0.79). Comparing QT and HS group during GNRB2 testing at 150N and 200N force also no significant difference was seen: QT group GNRB2 150N 1.23 mm (SD 0.96) vs HS group GNRB2 150N 1.66 mm (SD 1.34) (U = 97.5, p = 0.55); QT group GNRB2 200N 1.21 mm (SD 0.95) vs HS group GNRB2 200N 1.32 mm (SD 1.05) (U = 95, p = 0.98). Conclusions Although there is no significant difference in knee stability postoperatively after ACLR whether HS or QT autograft was used but tendency can be seen that QT graft has slight advantage. These results are primary but also promising that with increased sample size they could be more reliable and QT as great autograft option more frequently would be used for ACLR in adolescents.