All-Inside Quadrupled Semitendinosus vs. BTB ACL Reconstruction in Young Athletes: RCT

Abstract

Anterior cruciate ligament (ACL) reconstruction is challenging in young athletes. An important clinical question is optimal graft choice in this high-risk group. The purpose of this investigation was to compare clinical outcomes of ACL autograft reconstruction using all-inside GraftLink quadrupled semitendinosis (GraftLink) versus the “gold standard” bone-patellar tendon-bone (BTB) in a high-risk athletic population 24 years or younger. Skeletally mature candidates younger than 24 years old with an ACL tear were randomized into either the GraftLink (n=32) or BTB (n=32) groups and were followed for two years. MRIs were obtained at one-year follow-up, and radiographs were obtained at two-year follow-up. The primary outcome measure was KT- 1000 stability testing. Secondary outcome measures included: IKDC Knee Evaluation Form, IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Scale, and SF-12. At 2-year follow-up, no statistical difference existed with KT-1000 measured side to side laxity between GraftLink (0.3 ± 0.7 mm) and BTB (0.0 ± 0.8 mm) (p = 0.197). Additionally, no statistical differences between the groups were found for any secondary outcome measure or with regards to imaging findings. BTB patients reported significantly higher postoperative pain scores at days 3 (p=0.05) and 7 (p=0.018) and had significantly greater kneeling pain at 2 years (p < 0.019). A return to sport questionnaire at 2 years revealed no significant difference between the groups for returning to preoperative level of sport activity (83% GraftLink, 74% BTB; p=0.415). Two graft retears (7%; p=0.222) occurred in the GraftLink group. Three patients in the BTB group experienced ACL tears in the contralateral knee (9%; p=0.239). ACL reconstruction with all-inside quadrupled semitendinosis autograft GraftLink construct was equivalent to patellar BTB autograft based on KT-1000 stability testing and validated outcome measures, including IKDC, in athletes 24 years or younger (average age 17.7). There was no significant difference in graft retear rate or return to sport at the same preoperative level between the groups. However, there was significantly less kneeling pain in the GraftLink cohort.