5-Year Survival of Pediatric Anterior Cruciate Ligament Reconstruction With Living Donor Hamstring Tendon Grafts

Presenter’s name (Last, First): Cooper, Robert

Qualifications: MBBS

Affiliations: NSW Health

Other authors:
Emma L. Heath, MPhty, Lucy J. Salmon,BAppSci (Physio), PhD, Evangelos Pappas, PT, PhD, OCS, Justin P. Roe, MBBS, FRACS, and Leo A.Pinczewski, MBBS, FRACS

Email: robertbcooper83@gmail.com

Background / Introduction:
It is well accepted that there is a higher incidence of repeat anterior cruciate ligament (ACL) injuries in the pediatric population after ACL reconstruction(ACLR) with autograft tissue compared with adults. Hamstring autograft harvest may contribute to the risk for repeat ACL injuries in this high functional demand group. A novel method is the use of a living donor hamstring tendon (LDHT) graft from a parent; however, there is currently limited research on the outcomes of this technique, particularly beyond the short term.

Patients / Methods:
Between 2005 and 2014, 247 (of 265 eligible) consecutive patients in a prospective database, having undergone primary ACLR with the use of an LDHT graft and aged less than 18 years, were included. Outcomes were assessed at a minimum of 2 years after surgery including data on ACL reinjuries, International Knee Documentation Committee (IKDC) scores, and current symptoms, as well as factors associated with the ACL reinjury risk were investigated.



Patients were reviewed at a mean of 4.5 years (range, 24-127 months[10.6 years]) after ACLR with an LDHT graft. Fifty- one patients (20.6%) sustained an ACL graft rupture, 28 patients (11.3%) sustained a CACL rupture, and 2 patients sustained both an ACL graft rupture and a CACL rupture (0.8%). Survival of the ACL graft was 89%, 82%, and 76% at 1, 2, and 5years, respectively. Survival of the CACL was 99%, 94%, and 86% at 1, 2, and 5 years, respectively. Survival of the ACL graft was favor- able in patients with Tanner stage 1-2 at the time of surgery versus those with Tanner stage 3-5 at 5 years (87% vs 69%, respectively; hazard ratio, 3.7; P = .01). The mean IKDC score was 91.7. A return to preinjury levels of activity was reported by 59.1%.

After paediatric ACLR with an LDHT graft from a parent. The 5-year survival rate of the ACL graft was 76%. High IKDC scores and continued participation in sports. Favourable survival of the ACL graft in patients with Tanner stage 1-2. Thus, an LDHT graft from aparent is an appropriate graft for physically immature children.

Level of Evidence & Study type: Case series; Level of evidence, 4.

Declarations of Conflict: No conflicts of interest