Orthopedic surgeons at Children’s Healthcare of Atlanta recently introduced a new anterior cruciate ligament (ACL) technique for pediatric and adolescent patients that more successfully compensates for smaller graft size than the standard approach does.
New ACL Technique Improves Pediatric Treatment
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Through their own clinical practice, they found that pediatric patients whose ACL grafts were enlarged with cadaver tendons had more than double the risk for experiencing a graft tear than patients whose grafts were made larger by folding their own hamstring an additional time. The findings titled “Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents,” were published in the American Journal of Sports Medicine in May 2019.
The original goal of the study was to just confirm that adding cadaver tendon grafts with autografts worked as well in pediatric patients as adult patients undergoing ACL reconstruction. Three hundred and fifty-four patients between the ages of 10 and 19 were included in the study where they looked specifically at which ACL reconstruction methods would more likely lead to a re-tear or a graft rupture.
Crystal Perkins, M.D., one of the study leaders, said, “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. Our Sports Medicine team spends a significant amount of time and energy looking carefully at our outcomes in an effort to ensure we are providing the highest quality of care to our patients and families.”
Cliff Willimon, M.D., another study leader added, “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. 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.”
Sports orthopedic surgeons at Children’s Healthcare of Atlanta have also been using patellar and quadriceps tendons autografts in patients.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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