Postoperative Strength Differences at Short-Term Follow-Up Vary Based on Autograft Harvest Site After Adolescent Transphyseal Anterior Cruciate Ligament Reconstruction

Abstract

PurposeThe purpose of this study was to compare the clinical and patient-reported outcomes of adolescent patients who underwent anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) versus hamstrings tendon (HT) autograft. MethodsThis was a retrospective cohort study of adolescent patients ≤18 years treated at a single tertiary care children’s hospital who underwent primary transphyseal ACLR using QT or HT between January 2018-December 2019. All patients had minimum 6-month follow-up. Outcomes included isokinetic strength testing, postoperative PROMIS and IKDC scores, and complications. These were compared between QT and HT cohorts. ResultsA total of 84 patients were included (44 HT, 40 QT). The QT cohort had a higher proportion of male patients (62.5% vs 34.1%, p=0.01). At 3 months, those with HT had lower Hamstrings/Quadriceps (H/Q) strength ratios (60.7±11.0 vs 79.5±18.6, p<0.01) and flexion-limb symmetry index (LSI) (85.6±16.1 vs 95.5±15.7, p=0.01), while patients with QT had lower extension-LSI (67.3±9.5 vs 77.4±10.7, p<0.01). The H/Q ratio was lower at 6 months for patients with HT (59.4±11.5 vs 66.2±7.5, p<0.01). PROMIS/IKDC scores were not different at 3 months or latest follow-up. Patients with QT had more wound issues (20.0% vs 2.3%, p=0.01). Those receiving HT autograft had more ipsilateral knee injuries (18.2% vs 2.5%, p=0.03), but there was no difference in graft failure for HT and QT ACLR (9.1% vs 2.5%, p=0.36). ConclusionThere were no differences in PROM between patients receiving QT and HT autografts. QT grafts had more post-operative wound issues but a lower rate of ipsilateral knee complications (graft failure or meniscus tear). Differences in quadriceps and hamstrings strength post-operatively compared to the contralateral limb were observed for adolescent ACLR patients receiving QT and HT autografts, respectively. This contributed to higher H/Q ratios seen at 3 and 6 months postoperatively for patients receiving QT autografts. Level of EvidenceLevel III, retrospective comparative therapeutic study