Comparison of Bone-Patella Tendon-Bone (Btb) and Quadriceps Autograft for Acl Reconstruction in Patients Under 18 Years of Age

Abstract

Background: Graft choice for ACL reconstruction in patients under 18 years old remains controversial. BTB autograft has long been considered for young athletes who are at or near skeletal maturity. Quadriceps autograft has emerged as an alternative graft choice in the young patient population. However, there remains a paucity of comparative outcomes. Hypothesis/Purpose: Our purpose is to compare subjective outcomes and complications of ACL reconstruction in patients under 18 years old using either BTB or quadriceps autograft. Our hypothesis is that there will be no difference in subjective outcome or complication between groups. Methods: Following IRB approval, retrospective review of prospectively collected data identified consecutive cohorts of patients under 18 years old undergoing ACL reconstruction with either BTB or quadriceps autograft. Surgery was performed by a single sports fellowship trained surgeon between 2011-2019. Patients undergoing concomitant osteotomies, cartilage restoration, and other ligament reconstruction procedures were excluded. Pre- and post-surgical patient reported outcomes (PROs) including IKDC, KOOS, PROMIS, SANE, Tegner, and Marx were compared between groups. Complications requiring re-operation (i.e., infection, stiffness, reconstruction failure) were recorded. Results were analyzed statistically. Results: 71 patients met inclusion criteria. There were 41 BTB and 30 quadriceps autografts. Mean age was 16.5 years in the BTB group and 14.5 in the quadriceps group (p=0.0000006). 27 of 41 (66%) BTB and 13 of 30 (43%) quadriceps were female. There were no significant differences in PROs between groups. At minimum 6-month follow-up (range 6-25.7 months), patients in both quadriceps and BTB autograft cohorts reported statistically significant improvements in IKDC scores (31.10%, p=0.0009; 34.25%, p=0.00000008), all KOOS domains, SANE (41.80%, p=0.0000006; 42.42%, p=0.000000002), and Tegner scores (2.99%, p=0.0002; 3.35%, p=0.000004). Post-operative PROs were not significantly different between groups (p>0.05). Complications were low and not significant between groups. Both quadriceps and BTB autograft cohorts required 3 post-operative re-operations (10% and 7%, p=0.7), each group including 2 revision reconstructions (7% and 5%, p=0.8) and 1 procedure for stiffness (3% and 2%, p=0.8). Conclusion: For ACL reconstruction in patients under 18 years old, both BTB and quadriceps autografts demonstrated significant subjective improvements and low rates of complications requiring re-operation. Quadriceps autograft appears to be a safe and effective alternative to BTB autograft in this challenging patient population. [Table: see text][Table: see text]

Quadriceps tendon autograft for pediatric anterior cruciate ligament reconstruction results in promising postoperative function and rates of return to sports: A systematic review

“…Eleven studies (487 patients) reported the occurrence of postoperative complications, wherein two studies reported solely on the incidence of either graft failure or ipsilateral arthrofibrosis (152 patients) (Table 2) [1, 7, 19, 26, 33, 43, 51, 53, 54, 71, 75]. One study (80 patients) reporting solely on the incidence of arthrofibrosis noted its occurrence in 4/80 patients (5%) [51].…”

“…The initial literature search yielded 1216 unique studies, of which six met the inclusion and exclusion criteria for this systematic review [19, 26, 33, 43, 47, 54]. Furthermore, eight conference abstracts were included [1, 7, 39, 51, 53, 66, 71, 75]. No additional studies were included upon repeating the search strategy, nor through manually searching references of included studies and pertinent review papers (Fig.…”

“…Three studies (151 patients) reported data on postoperative IKDC subjective scores at final reported follow‐up, with mean scores ranging from 75.9 to 94.0 (Fig. 3) [7, 19, 71]. One study (21 patients) reported postoperative KOOS subscale scores, whereby patients were reported to have a pooled mean value of 94.6 ± 6.7 (95% CI 93.6–95.6) for KOOS Pain, 91.4 ± 8.9 (95% CI 90.1–92.8) for KOOS Symptoms, 98.9 ± 1.7 (95% CI 98.6–99.1) for KOOS Activities of Daily Living (ADL), 92.2 ± 9.9 (95% CI 90.7–93.7) for KOOS Sports and Recreational Function (Sports/Rec), and 70.5 ± 19.7 (95% CI 67.6–73.5) for KOOS QoL [1].…”

“…Forest plot of the mean IKDC subjective scores at final reported follow‐up following QT autograft ACL reconstruction in pediatric patients ( n = 81 [19], n = 40 [7], n = 30 [71], respectively)…”

“…Importantly, there were no incidents of rectus tendon retraction, patellar fracture, compartment syndrome, persistent anteroposterior and/or rotational instability, anterior knee pain, or infections reported in the literature. [7] Retrospective cohort study (III) January 2018-December 2019 40 Levy et al [39] Retrospective cohort study (III) October 2017-April 2019 33 Ouweleen et al [51] Retrospective cohort study (III) 80 Patel et al [53] Retrospective cohort study (III) 45 Schein et al [66] Retrospective cohort study (III) 62 15.7 ± 1.4 Sherman et al [71] Retrospective…”