Abstract
Background:
Pediatric anterior cruciate ligament reconstruction (ACLR) rehabilitation routinely requires a minimum of 9-12 months before returning to sports [1]. There is limited literature regarding early (pre-clearance) graft failures in this population. Therefore, the purpose of this study is to describe the incidence and characteristics of pediatric ACLR graft failure occurring ≤ 8-month postoperatively utilizing a large, multi-center prospective quality improvement registry.
Objectives:
In patients with early ACL graft failure, rates of failure will be different amongst graft types.
Methods:
A prospective, surgeon driven multi-center registry (26 institutions and 43 surgeons) was queried for consecutive ACLR between 2018-2025. Patients who underwent isolated ACLR at ≤19 years of age and had a minimum of 8 months follow-up were included. Graft failure was defined by requiring revision of ACLR or reinjury confirmed by advanced imaging. Demographics, graft type, drilling techniques, femoral and tibial fixation techniques and fixation devices, and postoperative rehabilitation data were analyzed. Descriptive statistics were utilized.
Results:
3,337 ACLR with minimum 8-month follow-up were analyzed. 35 graft failures which occurred ≤8-month postoperatively were identified, for an overall early graft failure rate of 1.05%. The mean age of patients was 15.2 ± 1.6 years, 57.1% were male, and mean BMI was 22.6 ± 4.1. There were 15 (42.9%) patients with closed physes, 10 (28.6%) with closing physes, and 7 (20.0%) with open physes. 33 (94.3%) were primary ACLR . Mean operative time was 102.2 ± 32.9 minutes. Graft failures were: 11 hamstring autografts (30.5%) and 15 (41.7%) soft tissue quadriceps tendon grafts, which led to an early failure rate of 1.3% for hamstring autografts and 1.5% for quadriceps tendon autografts. The early failure rate for bone-patellar tendon-bone autografts was 0.3% (n=2) and was 0.3% (n=1) for IT band autografts. Four (11.4%) failures occurred in the setting of additional lateral extra-articular tenodesis. Fixation methods of early ACL graft failures are represented in Table 1. Variations were noted in post-operative restrictions (Table 2).
Conclusion:
In 3,337 pediatric ACLR, the early (≤ 8-month) graft failure rate following ACL reconstruction in pediatric patients was 1.05%. Among graft types, the incidence of early failures was highest in hamstring autograft and soft tissue quadricep autografts. There were seemingly fewer early graft failures in grafts with the addition of a lateral extra-articular tenodesis.
