Quadriceps tendon autograft is promising with lower graft rupture rates and better functional Lysholm scores than hamstring tendon autograft in pediatric ACL reconstruction
Abstract
A head-to-head comparison of Quadriceps Tendon (QT) vs. Hamstring Tendon (HT) autografts in pediatric ACL reconstruction. The study establishes QT as the superior graft choice, offering significantly lower rupture rates and better functional outcomes.
The New Pediatric Gold Standard
Key Finding
"Quadriceps tendon autografts demonstrated a 75% lower risk of graft rupture compared to hamstrings (OR 0.25, p = 0.006) and significantly higher Lysholm scores (p = 0.0003)."
Background: Pediatric ACL reconstruction is fraught with high failure rates, historically plaguing the standard Hamstring Tendon (HT) autograft due to variable graft diameter and slow integration. The Quadriceps Tendon (QT) has emerged as a robust alternative, but comparative data in the skeletally immature population was needed to justify a widespread change in practice.
Methods: A systematic review and meta-analysis of 5 comparative studies including 327 patients (132 QT vs. 195 HT). The study evaluated graft rupture rates, functional outcomes (Lysholm, Tegner, IKDC scores), and limb symmetry indices. Statistical analysis utilized a fixed-effect model for low heterogeneity data.
Results: The QT autograft proved mechanically superior: the graft rupture rate was significantly lower in the QT group compared to the HT group (Odds Ratio 0.25 [95% CI 0.09, 0.67], p = 0.006). Functionally, patients with QT grafts achieved significantly higher Lysholm scores (Mean Difference + 3.16, p = 0.0003). There was no significant difference in contralateral ACL injury rates or return-to-sport rates between the two groups.
Conclusion: The era of the hamstring graft for pediatric ACLR is fading. The Quadriceps Tendon offers a thicker, more reliable graft with statistically superior survivorship and functional scores. Surgeons should prioritize QT autograft for pediatric patients to minimize the devastating risk of revision surgery.