Comparison of Early Lower Extremity Functional Recovery in Pediatric Patients Following Anterior Cruciate Ligament Reconstruction Using Hamstring Versus IT Band Autograft

Abstract

Objectives:The influence of graft type and gender in anterior cruciate ligament reconstruction (ACLR) has not been adequately studied in pediatric patients. The purpose of this study was to compare parameters of early lower extremity functional recovery among three cohorts of pediatric patients under 15 years-old: pediatric males who underwent ACLR with hamstring grafts (PM w/HS), pediatric females with hamstring grafts (PF w/HS), and pediatric males with IT band graft (PM w/ITB).Methods:A prospective cohort study design was used. At 6-month post-operative visits following ACLR, thigh circumference, knee ROM (extension and flexion), strength (quadriceps, hamstrings, hip abductors, and hip extensors), Y-balance (anterior, posterolateral, and posteromedial reach), and functional hop tests (single, triple, cross-over, and 6 meter timed hops) were assessed in all ACL-R under 15 years-old. Limb symmetry index was used to compare deficits between involved and uninvolved limb between the three graft groups (PM w/HS, PF w/HS, and PM w/ITB). There was an inadequate number of pediatric females who underwent ITB ACL-R for analysis. Analysis of variance (ANOVA) with post-hoc correction was employed.Results:A total of 87 pediatric ACLR patients (PM w/HS: N=20, Age:14.3±1.1; PF w/HS: N=33, Age:13.9±0.7; PM w/ITB: N=34, Age:13.2±1.3) were examined. There was no statistically significant difference in ROM and Y-balance tests performance between the cohorts. Of the various additional comparisons analyzed, only the following findings were statistically significant: (a) PM w/HS demonstrated greater thigh circumference deficits (-3.7% relative to healthy limb) than PM w/ITB (-1.5% relative to healthy limb, p=0.024); (b) PM w/HS group showed greater hamstring strength deficits (-34.1% relative to healthy limb) than PM w/ITB (-7.1% relative to healthy limb, p=0.001). The hamstring strength deficits of PF w/HS (-13.3% relative to healthy limb) were not statistically different from either of the male cohorts. (c) PM w/HS cohort showed greater deficits in the triple hop test (-40.1% relative to healthy limb) compared to PM w/ITB (-17.9% relative to healthy limb, p=0.019) and PF w/HS (-10.2% relative to healthy limb, p=0.001).Conclusion:While there is a slight age differences exist, PM w/HS patients demonstrated significant thigh circumference, hamstring strength, and functional hop test deficits compared to PM w/ITB at approximately 6 months following ACLR. Autograft type may influence strength and functional recovery following ACLR in pediatric patients. Approximately at 6 months post-operatively, PM w/ITB showed superior recovery in thigh circumference, hamstring strength, and triple hop tests, compared to PM w/HS. Additional research correlating timing and nature of functional recovery with graft retear and athletic performance are warranted.