O3267: Subsequent Isolated Meniscus Tears Following Pediatric Anterior Cruciate Ligament Reconstruction as an Indicator of Graft Failure: An Assessment of Hamstring and Quadriceps Tendon Autografts

Background: Anterior cruciate ligament (ACL) ruptures have become increasingly prevalent among pediatric/adolescent athletes over the recent decades. Recent research has shown a 4-10% rate of subsequent meniscal tears following ACL reconstruction (ACLR), but it is not clear how ACL graft choice might affect this rate of injury. We aimed to assess differences in the rate of subsequent isolated meniscus tears following ACLR between hamstrings autograft (HS) and quadriceps tendon autograft (QT).

Methods: We conducted a retrospective review of patients up to 24 years of age who underwent ACLR using hamstrings or quadriceps tendon autograft between 2007 and 2020 at a single tertiary care children’s hospital. Subsequent meniscus tears were classified as re-tears if the meniscus had been previously torn and repaired at the time of index ACLR and new tears if they were not previously injured. We collected demographics and details regarding subsequent meniscal tears. Descriptive statistics, bivariate analyses, and logistic regressions were performed.

Results: 1,007 patients (566 [56.1%] female) with median (IQR) age 15.5 (range: 8.3-24.1) years were enrolled. No significant difference in age, gender, or BMI was observed between graft types (all p>0.05). Follow-up data was available for mean 1.1 years (range: 0.0-8.6) after surgery for the HS group and 1.3 years (0.0-5.1) for the QT group. Overall, 4.0% of patients sustained a subsequent isolated meniscal tear following ACLR. All of these patients had a competent ACL graft on exam at the time of meniscus tear diagnosis, as well as on MRI and/or arthroscopy. The rate of subsequent isolated meniscal tear was significantly different between the HS and QT groups (p=0.004) with 40 subsequent meniscus tears occurring in patients who had HS autograft and 1 occurring in a patient with a QT autograft. This statistical finding persisted when considering only medial meniscus tears (p < 0.001), but not when focusing only on lateral meniscus tears (0.224). Similar findings resulted when considering only meniscal re-tears (see Table 1).

Conclusion: The results of this study suggest that the current use of QT during ACLR is associated with lower risk of subsequent isolated meniscal tear when compared to the prior use of HS in adolescent and young adult patients. Pediatric sports medicine surgeons may consider the increased risk of subsequent meniscal tear following ACLR with HS compared to QT when considering graft selection.