Comparison of Clinical Outcomes, Revision Rates, and Sports Participation Between Hamstring and Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients: A Retrospective Cohort Study

Background: In recent years, anterior cruciate ligament (ACL) injuries in children and adolescents (age ≤18 years) have been increasing, and the quadriceps tendon (QT) autograft has been gaining popularity for ACL reconstruction. However, there is no consensus regarding the graft choice for ACL reconstruction in these young patients. There has been a paucity of literature comparing the functional outcomes of hamstring tendon (HT) and QT autografts for ACL reconstruction in patients aged ≤18 years. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of HT and QT autografts for ACL reconstruction in pediatric and adolescent patients (age ≤18 years) in terms of patient-reported outcome measure (PROM) scores, knee stability, graft failure rates, and sports participation after ACL reconstruction. The hypothesis was that the QT autograft would result in better functional outcomes with a high rate of return to sporting activity and a low rate of graft failure after ACL reconstruction compared with the HT autograft in this population. Study Design: Retrospective cohort study; Level of evidence, 3. Methods: From 2010 to 2022, there were 2417 ACL reconstruction procedures performed at our institution. The inclusion criteria were primary ACL reconstruction using an HT or QT autograft and age ≤18 years. The exclusion criteria were revision ACL reconstruction; utilization of a graft type other than HT and QT autografts; and concomitant posterior cruciate ligament injuries, contralateral knee injuries, and conditions that might interfere with a standard postoperative rehabilitation protocol. A minimally invasive technique was used for QT autograft harvesting. The size of the QT graft ranged from 8 to 9 mm with specific instrumentation. Similarly, the size of the HT graft ranged from 8 to 9 mm. Patients were evaluated preoperatively and at 2-year follow-up for the Lysholm knee score, Tegner activity level, and visual analog scale (VAS) for pain; knee stability (Lachman and pivot-shift tests); graft failure; and sports participation. The Lachman test and pivot-shift test were performed preoperatively under anesthesia and postoperatively at 2-year follow-up. Results: The number of patients in the HT and QT groups was 77 and 80, respectively. The 2 groups did not differ significantly in terms of age, sex, and concomitant injuries. No significant difference was found in preinjury PROM scores (Lysholm, Tegner, and VAS) and knee stability between the 2 groups ( P > .05). Similarly, no significant difference was observed at 2-year follow-up between the 2 groups for PROM scores and knee stability ( P > .05). The Lysholm, Tegner, and VAS scores improved to preinjury values in both the groups, and no significant difference was found in Lysholm, Tegner, and VAS scores between preinjury and 2-year follow-up ( P > .05). At 2-year follow-up, both the groups achieved sports participation at the preinjury level ( P > .05). Graft failure occurred in 11 (14%) and 8 (10%) patients of the HT and QT groups, respectively. The rate of failure did not differ significantly between groups ( P > .05). Conclusion: A QT autograft for ACL reconstruction led to similar clinical outcomes, revision rates, and sports participation compared with an HT autograft in pediatric and adolescent patients.