Outcomes of Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients:2-Year Follow-Up

BACKGROUND: The quadriceps tendon (QUAD) autograft has recently become an alternative to the hamstring tendon autograft that demonstrates superior preliminary outcomes in pediatric anterior cruciate ligament reconstruction (ACLR). PURPOSE: To evaluate 2-year clinical and patient-reported functional outcomes of primary ACLR with soft tissue QUAD autograft in skeletally immature patients. METHODS: Consecutive skeletally immature patients who underwent ACLR with QUAD autograft were included. All cases utilized full thickness soft tissue QUAD autograft without a bone plug and were performed on patients with open growth plates. Preoperative demographic and surgical data were collected (Table 1). The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal (AE) and complete transphyseal (CT). Patients were followed for a minimum of 24 months with successive clinical visits or contacted via telephone. Information regarding the return to sports and concomitant or subsequent surgical procedures was collected. KT-1000 was performed post-operatively, and Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject at their 2-year follow-up appointment. RESULTS: The final cohort included of 60 consecutive adolescent patients aged 11.1 to 17.1 (13.9 ±1.2) with a minimum follow-up of 2 years. One patient was lost to follow-up. Prior to surgery, 86% of patients reported playing team sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. 21 (35%) patients underwent AE and 39 (65%) underwent CT ACLR. Additionally, 35 (58%) underwent an a lateral extra-articular tenodesis procedure using the iliotibial band (ITB) with a modified Lemaire technique, and 5 (8%) patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum, both procedures were performed for non-modifiable risk factors as previously published for hamstring autograft ACLR. The rate of graft failure was 0%, and 10 patients had additional surgical procedures, of which 4 were concomitant removal of hardware for hemi-epiphysiodesis, 3 were contralateral ACLR, 3 were meniscal injuries that required surgical intervention and 2 were lysis of adhesions. The mean KT-1000 at 2-year follow-up was -0.36 ±0.75. The median Pedi-IKDC score was 87, and the median HSS-Pedi FABS score was 25. At 2 years after surgery, 90% patients reported returning to sports. CONCLUSION: This study reveals that QUAD autograft ACLR had a low failure rate when compared to previously reported studies of ACLR with hamstring autograft. Based on these results, we recommend this technique for skeletally immature patients undergoing ACLR.