scholarly journals DIFFERENCES IN ACUTE POSTOPERATIVE PAIN AFTER ACL RECONSTRUCTION IN ADOLESCENT PATIENTS: ALL SOFT-TISSUE QUADRICEPS VERSUS HAMSTRING AUTOGRAFT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0014
Author(s):  
Brandon Levy ◽  
Erica Holland ◽  
Viviana Bompadre ◽  
Gregory A. Schmale ◽  
Michael Saper
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Management Plan ◽  
Hamstring Autograft ◽  
Acute Postoperative Pain ◽  
Pain Scores ◽  
Adolescent Patients ◽  
Tendon Autograft

Background: Postoperative pain after anterior cruciate ligament (ACL) reconstruction is a subjective experience that contributes significantly to patient satisfaction and subjective outcomes. As such, it is important for surgeons to counsel their patients and set appropriate expectations following surgery. ACL reconstruction with hamstring (HS) tendon autograft remains the most popular graft choice in adolescent patients with open physes, yet recently, reconstruction using all soft-tissue quadriceps tendon autograft has gained in popularity. However, studies are lacking that evaluate acute postoperative pain after quadriceps autograft. Hypothesis/Purpose: To investigate differences in acute postoperative pain between adolescent patients undergoing ACL reconstruction with all soft-tissue quadriceps versus HS autograft. Methods: A retrospective review was performed of 65 patients that underwent primary ACL reconstruction using either quadriceps (n = 33) or HS (n = 32) autografts between October 2017 and April 2019. All patients received ultrasound-guided adductor canal catheters and single-shot sciatic nerve blocks preoperatively and followed a standard postoperative multi-modal pain management plan. Intraoperative and postoperative intravenous (IV) morphine equivalents (MEQ), post-anesthesia care unit (PACU) length of stay (LOS), and PACU pain scores (numeric rating scale, 0-10) were recorded. Pain scores and supplemental oxycodone use were recorded on postoperative days (POD) 1-3. Differences were compared between the two groups. Results: The mean age at the time of surgery was 15.2 ± 1.5 years. There were no statistically significant differences in age ( p = 0.62), sex ( p = 0.72), BMI ( p = 0.18), concomitant meniscus repairs ( p = 0.71), or surgical time ( p = 0.52) between the two groups. There were no statistically significant differences in intraoperative IV MEQs ( p = 0.44), PACU IV MEQ ( p = 0.43), or PACU LOS ( p = 0.47) between the two groups. Patients treated with quadriceps autograft has lower max PACU pain scores (3.2 ± 3.2 vs 4.1 ± 3.1; p = 0.27) and required less supplemental oxycodone doses on POD 1 (1.1 ± 1.2 vs 1.8 ± 1.6; p = 0.07) but the differences were not statistically significant. Max pain scores (at rest and with movement) on POD 1-3 and oxycodone use on both POD 2 and POD 3 were similar between groups. Conclusion: In the setting of a multi-modal pain management plan including regional anesthesia, adolescent patients undergoing ACL reconstruction with quadriceps tendon autograft and hamstring autograft have similar pain levels and opioid use in the acute postoperative period.

scholarly journals Clinical Outcomes of All Soft Tissue Quadriceps Tendon Autograft in ACL Reconstruction

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0031
Author(s):  
John W. Xerogeanes ◽  
William Godfrey ◽  
Aaron Gebrelul ◽  
Ajay Premkumar ◽  
Danielle Mignemi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Tendon Autograft

scholarly journals 6-MONTH RETURN TO SPORTS TESTING FOLLOWING ACL RECONSTRUCTION IN ADOLESCENTS WITH QUADRICEPS TENDON AUTOGRAFT VERSUS HAMSTRING AUTOGRAFT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Elizabeth S. Liotta ◽  
Dai Sugimoto ◽  
Kathleen J. Maguire ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Quadriceps Strength ◽  
Control Group ◽  
Return To Sports ◽  
Care Hospital ◽  
Hamstring Autograft ◽  
Muscle Testing ◽  
Operative Limb ◽  
Tendon Autograft

Background: Quadriceps tendon autograft represents an increasingly popular graft option for ACL reconstruction (ACLR). However, there is a paucity of literature regarding the early post-operative effects of this graft technique on functional recovery, particularly in adolescents. Purpose/Hypothesis: To quantify post-operative strength, dynamic balance, and functional hop test performance in adolescents 6 months following ACLR with a quadriceps tendon autograft (ACLR-Q) and compare to an adolescent control group who underwent ACLR with hamstring autograft (ACLR-HS). Methods: Patients 12-19 years-old who underwent primary ACLR-Q from 2017-2019 by a single surgeon at a pediatric tertiary care hospital and performed return to sports (RTS) assessments between 5-9 months post-operatively were included. Exclusion criteria were prior ipsilateral or contralateral ACLR and concomitant procedures other than meniscal repair or meniscectomy. RTS tests included manual muscle testing of strength (hamstring, quadriceps, hip abductor), dynamic-Y-balance, and functional hop tests (single-hop, triple-hop, crossover, 6-meter timed hop). Limb Symmetry Index (LSI) was calculated for all measures and each was compared with an ACLR-HS control group using T-tests. One-way between-group multivariate analysis of covariance (MANCOVA) was utilized to control for any baseline differences. Results: There were no significant differences in age, BMI, sex, or rates of meniscal procedures between cohorts (Table 1). The small difference in time of RTS testing was controlled by MANCOVA model. ACLR-Q patients demonstrated a significantly smaller hamstring strength deficit (-3.6%) than the ACLR-HS group (-35.8%, p<0.001, Table 2). The ACLR-Q group showed a significantly greater deficit in quadriceps strength (-11.9% vs. 0.9%, p<0.001). Hamstring-to-quadriceps strength ratios (HS:Q) were lower in the ACLR-HS (operative limb: 0.34 +/- 0.13, non-operative limb: 0.52 +/- 0.01) than the ACLR-Q group (operative limb: 0.61 +/- 0.16, non-operative limb: 0.56 +/- 0.12). Deficits in anterior reach, composite Y-balance score, cross-over hop, timed hop, and single hop were significantly greater in the ACLR-Q group. The deficit in 6-meter timed hop was significantly greater in the ACLR-HS group. Conclusion: Quadriceps strength deficits were greater in adolescents undergoing ACLR-Q (LSI of approximately -12%), while hamstring strength deficits were greater in adolescents undergoing ACLR-HS (LSI of approximately -33%). Hamstring-to-quad ratios were greater in the ACLR-Q patients’ operative knees than their nonoperative knees, while they were significantly lower in the ACLR-HS patients’ operative knee than their nonoperative knees. Hop testing performance was mixed between the 2 graft cohorts. The degree to which these performance metrics influence eventual athletic performance and graft-retear remains a critical area of continued investigation. [Table: see text][Table: see text]

scholarly journals Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110566
Author(s):  
Soroush Baghdadi ◽  
David P. VanEenenaam ◽  
Brendan A. Williams ◽  
J. Todd R. Lawrence ◽  
Kathleen J. Maguire ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Quadriceps Tendon ◽  
Graft Size ◽  
Operative Notes ◽  
Tendon Autograft ◽  
Graft Diameter ◽  
Mri Measurements

Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Alexia G. Gagliardi ◽  
Patrick M. Carry ◽  
Harin B. Parikh ◽  
Jay C. Albright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

scholarly journals Allograft Augmentation of Hamstring Anterior Cruciate Ligament Grafts is Associated with Increased Graft Failure

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014
Author(s):  
Crystal Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Graft Failure ◽  
Activity Level ◽  
Population Characteristics ◽  
Hamstring Autograft ◽  
Inclusion Criteria ◽  
Graft Rupture ◽  
Graft Diameter

Objectives: ACL reconstruction in adolescents is commonly performed with hamstring autografts. In the adolescent population with very high activity levels, graft rupture is the most feared complication of ACL reconstruction. Young age, higher activity level, allografts, and small graft diameter have been shown to be predictors of graft failure. The applicability of this data to pediatric ACL reconstructions is limited due to heterogeneity of ages, graft constructs, and tunnel techniques. The purpose of this study is to evaluate the association of soft tissue graft constructs and graft rupture following pediatric transphyseal ACL reconstruction. Our hypothesis is that allograft-augmentation of grafts is associated with an increased risk of graft rupture. Methods: A single-institution retrospective review was performed of consecutive patients. Inclusion criteria were age less than 20 years and transphyseal ACL reconstruction with hamstring autograft, with or without allograft augmentation. Graft constructs included 4-strand doubled semitendinosus and gracilis (4-STG), 5-strand tripled semitendinosus and doubled gracilis (5-STG), 6-strand doubled gracilis and semitendinosus plus allograft (6-STGAllo), and 7-strand tripled semitendinosus and doubled gracilis plus allograft (7-STGAllo). Exclusion criteria included multiligament reconstruction and less than 6 months follow-up. The primary outcome was graft rupture. Results: Three hundred fifty-five patients (157 males, 198 females) with an average age of 15.3 years were identified to meet inclusion criteria. Graft constructs included 4-STG (198), 5-STG (91), 6-STGAllo (65), and 7-STGAllo (1). Average graft diameter was 8.3 mm 4-STG, 8.9 mm 5-STG, and 9.2 mm 6-STGAllo. Age and graft sizes were significantly different across groups with older patients (p <0.001) and larger graft sizes (p <0.001) being found in patients with allograft-augmented grafts. Mean duration of follow-up was 26 months (range 6-56 months). There were 51 graft ruptures (14.3%). The failure rate of each construct was 13.6% 4-STG, 11.9% 5-STG, and 19.7% 6-STGAllo. Time to graft failure was 16 months (range 2-40 months), with 49% of failures occurring before 12 months and 24% after 24 months. Twenty-four patients (6.7%) had a contralateral ACL tear during the follow-up period. Table 1 provides population characteristics by graft rupture status. This data suggests that patients who sustain a graft rupture may be slightly younger (p=0.07) and have lower BMI (p=0.07) than those patients without graft rupture. Odds ratios for graft failure by graft construct, controlling for age and graft size were calculated. Patients with 6-STGAllo grafts had an odds ratio of 2.6 (95% CI: 1.02, 6.50) of graft rupture as compared to 4-STG. Conclusion: ACL reconstruction with hamstring autograft combined with soft tissue allograft have a 2.6 times risk of graft rupture as compared to hamstring autograft without augmentation. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend tripling the semitendinosus to produce a larger graft diameter rather than augment with an allograft.

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