Midterm Outcomes of Hybrid Transepiphyseal ACL Reconstruction With Soft Tissue Quadriceps Tendon Autograft in Skeletally Immature Athletes.

Abstract

Background: Substantial developments in physeal-sparing surgical techniques for anterior cruciate ligament (ACL) reconstruction (ACLR) have demonstrated safety and efficacy in treating skeletally immature patients. However, outcomes using all-soft tissue quadriceps tendon (QT) autograft in this population are unknown.

Purpose: To evaluate outcomes including return to sport (RTS) and reinjury risk in skeletally immature patients ≥2 years after undergoing hybrid transepiphyseal ACLR using QT autograft.

Study design: Case series; Level of evidence, 4.

Methods: A consecutive series of skeletally immature patients who underwent primary QT autograft ACLR using a hybrid transepiphyseal technique with ≥2 years of follow-up were retrospectively analyzed. Outcomes included RTS (primary), ability to return to preinjury level of competition, and subsequent ipsilateral/contralateral knee injury (secondary).

Results: A total of 50 patients were identified and contacted, of which 40 (80.0%) (35 male; mean age, 12.6 years [range, 9.4-16.0 years]) completed the survey at 5.7 ± 2.8 years (range, 2.0-11.5 years) postoperation. Of those, 26 (65.0%) were competitive middle/high school athletes and 18 (45.0%) competed in ≥2 sports. At a mean of 10.6 ± 2.3 months (range, 6-17 months) postoperatively, 37 patients (92.5%) returned to unrestricted sports participation, and 35 patients (87.5%) resumed competition at their preinjury level. Five patients required subsequent ipsilateral knee surgery for ACL revision (n = 2; 5.0%), meniscal injury (n = 2; 5.0%), or symptomatic hardware (n = 1; 2.5%) after a mean of 4.4 ± 1.7 years (range, 2.8-7.1 years). Three patients (7.5%) sustained a subsequent contralateral ACL injury, and 1 patient sustained a contralateral posterior cruciate ligament sprain.

Conclusion: Findings of this study suggest that midterm outcomes of patients treated with hybrid transepiphyseal ACLR using QT autograft are promising, with a high and expedited RTS and relatively low graft tear risk.