Background: The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high. Purpose: To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon–patellar bone autograft (QPA). Study Design: Cohort study; Level of evidence, 3. Methods: Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires. Results: The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion. Conclusion: The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury.

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.

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The rate of anterior cruciate ligament (ACL) ruptures diagnosed among the pediatric and adolescent population is increasing. The rise in ACL injuries may be attributed to earlier sports specialization, year-round sports participation, increased awareness, and improved ability to diagnose the injury. Treatment options for pediatric or adolescent ACL injuries include nonoperative conservative treatment, ACL repair, or various techniques for ACL reconstruction. The best course of treatment for ACL rupture in young patients continues to be debated. Anterior cruciate ligament reconstruction with autograft is currently the gold standard and has been shown to be successful in restoring joint stability. This article reviews predisposing factors, common mechanisms, diagnostic procedures, and treatments for ACL rupture in adolescent patients, with a focus on using quadriceps patellar tendon autograft. [Orthopedics. 2018; 41(3):129-134.].