Natalie H Vaughn1, Mark L Dunleavy2, Trevor Jackson3, William Hennrikus4. 1. Department of Orthopaedics, Wake Forest Medical Center, Watlington Hall, 4th Floor, 1 Medical Center Boulevard Winston Salem, Winston-Salem, NC, 27157, US. 2. Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, 500 University Dr., 414 Hallmark South, Hershey, PA, 17033, USA. mdunleavy@pennstatehealth.psu.edu. 3. Department of Orthopaedics, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, 4602, Aurora, CO, 80045, US. 4. Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, 500 University Dr., 414 Hallmark South, Hershey, PA, 17033, USA.
Abstract
BACKGROUND: Multiple graft options exist for anterior cruciate ligament (ACL) reconstruction in an adolescent athlete. Patellar tendon harvest can lead to anterior knee pain, while hamstring tendon harvest can affect knee flexion strength and alter mechanics. Allograft is less desirable in pediatric patients due to the higher failure rate and slight risk of disease transmission. Quadriceps tendon autograft has rarely been reported for adolescent ACL reconstruction in the USA, but is an excellent option due to its large size, low donor site morbidity, and versatility. The purpose of this study is to report the outcomes of adolescents who have undergone ACL reconstruction using quadriceps tendon autograft. METHODS: Twenty-two ACL reconstructions using the quadriceps autograft were performed on 21 pediatric patients by the senior author between 2010 and 2017. The patient's demographics, injury characteristics, imaging, physical examination findings, operative findings, outcomes and sports were recorded. RESULTS: The average age at the time of surgery was 15 years. Two patients had open physes; the remainder had closing physes. 64% of patients had additional meniscal tears and 76% had bony contusions. The average duration of follow-up was 2.8 years (range 2-5 years). At final follow-up, there were no angular deformities or leg length discrepancies. The average quadriceps atrophy of the operative leg was 4 mm. The average Lysholm score was 98. 86% of patients returned to sports. No patients had re-rupture of their operative ACL. No incidences of infections, numbness, or anterior knee pain were reported. Two patients had a second arthroscopy for re-injury, revealing new meniscal tears but intact ACL grafts. CONCLUSIONS: Use of quadriceps tendon autograft for ACL reconstruction in adolescent patients allows reliable return to sport with minimal complications. LEVEL OF EVIDENCE: Level IV, retrospective case series.
BACKGROUND: Multiple graft options exist for anterior cruciate ligament (ACL) reconstruction in an adolescent athlete. Patellar tendon harvest can lead to anterior knee pain, while hamstring tendon harvest can affect knee flexion strength and alter mechanics. Allograft is less desirable in pediatric patients due to the higher failure rate and slight risk of disease transmission. Quadriceps tendon autograft has rarely been reported for adolescent ACL reconstruction in the USA, but is an excellent option due to its large size, low donor site morbidity, and versatility. The purpose of this study is to report the outcomes of adolescents who have undergone ACL reconstruction using quadriceps tendon autograft. METHODS: Twenty-two ACL reconstructions using the quadriceps autograft were performed on 21 pediatric patients by the senior author between 2010 and 2017. The patient's demographics, injury characteristics, imaging, physical examination findings, operative findings, outcomes and sports were recorded. RESULTS: The average age at the time of surgery was 15 years. Two patients had open physes; the remainder had closing physes. 64% of patients had additional meniscal tears and 76% had bony contusions. The average duration of follow-up was 2.8 years (range 2-5 years). At final follow-up, there were no angular deformities or leg length discrepancies. The average quadriceps atrophy of the operative leg was 4 mm. The average Lysholm score was 98. 86% of patients returned to sports. No patients had re-rupture of their operative ACL. No incidences of infections, numbness, or anterior knee pain were reported. Two patients had a second arthroscopy for re-injury, revealing new meniscal tears but intact ACL grafts. CONCLUSIONS: Use of quadriceps tendon autograft for ACL reconstruction in adolescent patients allows reliable return to sport with minimal complications. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Authors: Etienne Cavaignac; Benoit Coulin; Philippe Tscholl; Nik Nik Mohd Fatmy; Victoria Duthon; Jacques Menetrey Journal: Am J Sports Med Date: 2017-03-08 Impact factor: 6.202
Authors: Dennis C Crawford; Sara E Hallvik; Ryan C Petering; Samantha M Quilici; Loren O Black; Stephanie A Lavigne; Jodi Lapidus; Lynn M Marshall Journal: Knee Date: 2013-05-09 Impact factor: 2.199
Authors: Christopher C Kaeding; Brian Aros; Angela Pedroza; Eric Pifel; Annunziato Amendola; Jack T Andrish; Warren R Dunn; Robert G Marx; Eric C McCarty; Richard D Parker; Rick W Wright; Kurt P Spindler Journal: Sports Health Date: 2011-01 Impact factor: 3.843
Authors: Andrew T Pennock; Kristina P Johnson; Robby D Turk; Tracey P Bastrom; Henry G Chambers; Kelly E Boutelle; Eric W Edmonds Journal: Orthop J Sports Med Date: 2019-09-17
Authors: Harasees Singh; Isaac Glassman; Andrew Sheean; Yuichi Hoshino; Kanto Nagai; Darren de Sa Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-10-18 Impact factor: 4.114