ATLANTA (June 26, 2019) – Children’s Healthcare of Atlanta orthopedic surgeons have published a study on anterior cruciate ligament (ACL) reconstruction methods that suggests new best clinical practices for adolescent patients.
The paper, which was published by the prestigious American Journal of Sports Medicine this month, was authored by Crystal Perkins, MD; Michael Busch, MD; and Cliff Willimon, MD, all pediatric orthopedic surgeons at Children's. The key finding is that pediatric patients whose ACL grafts were made larger by adding cadaver tendons were more than two times likely to experience a graft tear than patients whose own hamstring was folded an additional time to create a larger graft.
Initially, however, the team set out to simply validate existing findings in adults in the adolescent population. That previous adult research suggested that combining autografts, or grafts from one’s own tissue, with allografts, or cadaver tendon grafts, may lead to improved ACL reconstruction outcomes. A similar finding would have been highly applicable to kids and teens requiring ACL surgeries, as they often have smaller hamstring tendons than that preferred by surgeons. Traditionally in adolescents, grafts have been made larger by adding a cadaver tendon or by folding the own patient’s tendon to create a thicker graft.
The outcomes of 354 patients between the ages of 10 and 19 were reviewed to examine if an ACL tear would recur or if the graft would rupture, and if so, what method had been used in surgery to strengthen the ACL. Results showed that certain types of grafts have lower rates of injuries and failure than others, specifically augmentation by allograft.
“This is an important finding and has changed our clinical practice, such that the use of allografts for ACL reconstruction in our patients is now highly unusual,” said Dr. Perkins. “Our sports medicine team spends a significant amount of time and energy looking carefully at our outcomes in an effort to help make sure we are providing the highest quality of care to our patients and families.”
Since the study concluded, sports orthopedic surgeons at Children’s have been using these insights to select the optimal graft for each individual patient. Due to the inconsistency in hamstring graft sizes among adolescents, other graft alternatives, such as patellar tendon and quadriceps tendon, are now the preferred graft choice over allografts.
“We pride ourselves in consistently reviewing our patients’ outcomes and modifying our practice based on this data to ensure we are delivering the highest quality care,” said Dr. Willimon. “It is also a clear example of the differences in treatment between young athletes and middle-aged adult athletes. This drives home that, at the end of the day, where you take them really does matter.”
Perkins, C.A., Busch, M.T., Christino, M., Herzog, M.M., Willimon, S.C. Allograft augmentation of hamstring anterior cruciate ligament autografts is associated with increased graft failure in children and adolescents. Am J Sports Med 2019;47(7):1576-1582.