Summary

Given paediatric ACL reconstruction patients have high graft failure rates, this study reports clinical outcomes of a growth plate sparing Anterolateral Tenodesis combined with a 4 strand single bundle hamstring autograft of 18 patients at 2 year review.

Abstract

Introduction

High re-injury rates in young patients undergoing anterior cruciate ligament reconstruction (ACLR) are reported, while those yet to reach skeletal maturity with open growth plates present a surgical dilemma. This study investigates the outcome of these patients undergoing ACLR combined with lateral extra-articular tenodesis (LET).

Methods

Between July 2018 and April 2020, 18 patients (14 males) with a mean age of 13.2 years (range 8-14) and a mean time from injury to surgery of 42 weeks (range 4 weeks to 7 years) underwent ACLR and LET. Patients were assessed at 6, 12 and 24 months via PROMs, graft laxity (KT-1000), knee extensor/flexor strength and hop testing. Limb Symmetry Indices (LSIs) were calculated. Return to sport (RTS) rates (at 2 years), re-operations and re-injuries were evaluated.

Results

A significant improvement (p<0.05) was observed for PROMs. The mean quadriceps (83.7%, 91.1%, 93.9%) and hamstrings (90.6%, 94.8%, 94.2%) strength LSIs increased over the 6, 12 and 24 month period. Mean LSIs for the hop tests ranged from 88.2-90.7%, 92.4-97.1% and 97.1-98.0% at 6, 12 and 24 months. Of the n=8 patients that have reached 2 years, n=6 demonstrated ‘normal’ knee laxity (<3mm side-to-side difference), with n=2 ‘nearly normal’ (3-5mm). All n=8 that have reached 2 years have returned to pivoting sports. To date there have been no re-operations, ipsilateral re-tears or contralateral ACL tears.

Conclusions

Good levels of function, RTS and re-injury rates have been observed thus far in a consecutive series of paediatric, skeletally immature patients undergoing ACLR and LET for persistent knee instability.