O0808 Oct.3: 3:15pm - Anterior Cruciate Ligament Reconstruction in the Pediatric Population: Outcomes of Quadriceps Versus Hamstring Autografts

Background/Purpose: Emerging evidence has suggested reduced donor site pain and equivalent/improved functional outcomes in adults undergoing ACL reconstruction (ACLR) with quadriceps (QT) autograft versus hamstrings (HT) and bone-tendon-bone grafts has prompted changing graft choices at our institution (Figure 1). Past studies comparing QT versus HT autografts in the skeletally immature have failed to assess postoperative strength or active range of motion (AROM) in addition to more commonly accepted patient-reported outcome measures (PROMs). Our study sought to compare 3- and 6-month outcomes including IKDC and PROMIS scores between pediatric patients treated with these two graft types.

Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary transphyseal ACLR from 1/2018-8/2019 at a single tertiary care children’s hospital without concomitant multiligamentous reconstruction was conducted. Outcomes at 3 and 6 months, including isokinetic strength testing, PROMIS and IKDC scores, and AROM were compared between patients receiving either HT or QT autografts. Hamstrings to quadriceps (H/Q) ratios were calculated using the ratio of the respective peak torque values normalized to body weight. Multiple imputation was utilized to minimize bias resulting from missed follow-up appointments.

Results: 71 patients met inclusion criteria with 29 patients receiving QT (Table 1). No differences in age (p=0.381) or BMI (p=0.141) were observed, though patients receiving QT were more often male (58.6% vs 33.3%, p=0.035). There were no differences in operative time (p=0.332) or proportion of patients requiring meniscus repair (p=0.720). At 3 months postoperative, those with HT had lower H/Q ratios (61.9±15.6 vs 79.6±23.4, p=0.001), while patients with QT had lower limb symmetry index in extension compared to the uninvolved limb (66.2±12.9 vs 78.0±12.2, p=0.001). The H/Q ratio was also lower at 6 months among patients receiving HT (61.0±11.6 vs 66.2±12.9, p=0.028). IKDC, PROMIS physical function, and PROMIS pain interference scores were not different between cohorts at either 3 or 6 months. There was no difference in AROM in flexion or extension between groups at 6 weeks, 3 months, or 6 months. Patients with QT were significantly more likely to have a post-operative surgical site infection or wound issue (13.8% vs 0%, p=0.024).

Conclusion: Significant differences in quadriceps strength at 3 months were observed for ACLR patients receiving QT compared to HT, contributing to higher H/Q ratios at 3 and 6 months postoperatively for patients receiving QT. However, these deficits did not impact PROMs or AROM. In our series, QT grafts appear to have a higher rate of postoperative infection or wound issues.