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Quadriceps tendon autograft for pediatric anterior cruciate ligament reconstruction results in promising postoperative function and rates of return to sports: A systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the performance of the quadriceps tendon (QT) autograft in pediatric anterior cruciate ligament reconstruction (ACLR).

Methods

A systematic search of MEDLINE, PubMed, and EMBASE was conducted on March 1, 2021. Studies of all levels of evidence reporting outcomes and/or complications after QT autograft ACLR in pediatric patients (≤ 18 years old) were eligible for inclusion. Study demographics, patient demographics, reported outcomes, and complications were abstracted. Screening and data abstraction were designed in accordance with PRISMA and R-AMSTAR guidelines. Descriptive statistics were presented when applicable, with data for heterogeneous outcomes presented in narrative summary fashion.

Results

A total of 14 studies examining 596 patients (46.3% female), mean age 15.4 years, were included in this systematic review. Mean postoperative Lysholm scores ranged from 94.0 to 99.5. Mean postoperative IKDC subjective scores ranged from 75.9 to 94.0. Limb symmetry index ranged from 96.8 ± 10.4 to 100.4 ± 7.6% across multiple hop tests. Return to sports (RTS) rates ranged from 88.9 to 91.7%. Eleven studies reported postoperative complications, whereby 16 patients (4.8%) experienced contralateral complications and injuries. Forty-six patients (9.4%) experienced ipsilateral complications, including ten graft failures (2.5%) and two growth disturbances (0.6%).

Conclusions

QT autograft ACLR in the pediatric population retains the potential of regaining a preinjury level of knee stability, and yields promising postoperative function and rates of RTS, yielding comparable outcomes relative to HT autograft and the reference-standard BPTB ACLR that have previously been described in the literature. Moreover, use of the QT autograft is associated with low rates of postoperative complications, including graft failure and growth disturbances in this active and high-risk patient population in observational studies to date. Therefore, clinical equipoise exists to further appraise the influence of QT autograft on postoperative outcomes compared to aforementioned autograft options in a randomized control trial fashion.

Level of evidence

IV.

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Acknowledgements

We thank Iman P.T.P. Khwaja for their ongoing support throughout this review.

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There was no outside funding or grants received that assisted in this study.

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Authors and Affiliations

  1. MacSports Research Program, McMaster University, Hamilton, ON, Canada

    Alexander Zakharia & Abhilash Uddandam

  2. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

    Darius L. Lameire

  3. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Hassaan Abdel Khalik, Jeffrey Kay & Darren de SA

  4. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Kanto Nagai & Yuichi Hoshino

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Contributions

All co-authors warrant that they participated in the development of this research paper. Specifically, AZ and AU completed the screening process, data abstraction, and conducted the quality assessment of included studies. JK conducted pertinent statistical tests and analyses. AZ, DLL, and HAK drafted the manuscript. DdS conceived the study idea and was integral to all steps of the project. DdS, YH, and KN edited the manuscript and provided expert insight. All authors have read the final manuscript and have approved for it to be submitted for publication. All authors have agreed to be accountable for all aspects of the work.

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Correspondence to Darren de SA.

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DdS received funding from the Canadian Orthopaedic Foundation and the Physicians’ Services Incorporated Foundation to conduct a study assessing QT autograft ACLR in the pediatric population.

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Appendix: Search strategy

Appendix: Search strategy

1. anterior cruciate ligament/

2. “anterior cruciate ligament”.ti,ab

3. ACL.ti,ab

4. 1 or 2 or 3

5. exp surgery/

6. operat*.ti,ab

7. surg*.ti,ab

8. reconstruct*.ti,ab

9. 5 or 6 or 7 or 8

10. exp Quadriceps Muscle/

11. quadricep* femoris.ti,ab

12. (rectus femoris or vastus intermedius).mp. or vastus lateralis.ti,ab. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

13. 10 or 11 or 12

14. 4 and 9 and 13

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Zakharia, A., Lameire, D.L., Abdel Khalik, H. et al. Quadriceps tendon autograft for pediatric anterior cruciate ligament reconstruction results in promising postoperative function and rates of return to sports: A systematic review. Knee Surg Sports Traumatol Arthrosc 30, 3659–3672 (2022). https://doi.org/10.1007/s00167-022-06930-7

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