2018 AOSSM Annual Meeting
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Internal Brace ACL Repair is Associated with High Failure Rate in the First Two Years Post-
Alexia Georgia Gagliardi, BA1, Patrick M. Carry, MS1, Ariel Kiyomi Daoud, BA2, Harin Bhavin Parikh, Medical Student2,
Jay C. Albright, MD1
1Musculoskeletal Research Center, Orthopedics Institute, Children’s Hospital Colorado, Aurora, CO, USA, 2Department of
Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Objectives: To compare graft/internal brace survival, self-reported functional outcomes, and joint laxity in
adolescents who underwent quadriceps tendon patellar autograft (QPA) reconstruction versus ACL repair with
internal brace ligament augmentation.
Methods: We identified all adolescent and pediatric subjects who underwent primary ACL reconstruction or repair
with internal brace augmentation between January 2013 and January 2016. Only subjects with a minimum of 6
months of follow-up were included. Graft failure, range of motion (ROM), complications, and demographic
information including age and gender was collected. Failure was defined as the need for revision surgery or MRI-
confirmed graft/internal brace failure. Subjects were prospectively contacted by telephone and were invited to either
schedule a follow-up appointment or to complete research questionnaires over the phone. Objective joint laxity
measures, KT1000, were obtained from a subset of subjects (N=25 QPA and N=6 repair group) that completed the
research visit. Wilcoxon rank sum tests were used to compare IKDC and joint laxity measure. Multi-variable Cox
proportional hazards regression analyses were used to compare failure-free survival in the two groups during the
first 24 months post-surgery.
Results: The final cohort included 132 patients in the QPA group (52% female) and 19 patients in the repair group
(53% female). The repair group tended to be younger (mean: 14.1 yrs, ±2.9 vs 15.5 yrs, ±1.8). Median duration of
follow-up was 2.1 years [range: 0.5-4 years] in the repair group compared to 1.2 years [range: 0.5-4 years] in the
QPA group. Within the first 24 months post-surgery, the cumulative incidence of failure was 3.8% (5/132) in the
QPA group compared to 52.6% (10/19) in the repair group. After adjusting for age, the hazard of failure in the repair
group was 22.1 [95% CI: 6.7 to 73.2, p <0.0001] times the hazard of failure in the QPA group. KT-1000 side-to-side
joint laxity measures in the repair group [Median: 2.5mm, range: -1mm to 7mm] were significantly [p=0.0212] higher
than the joint laxity measures in the QPA group [Median: 1.0mm, range: -1mm to 4mm]. There was no difference
[p= 0.3826] in IKDC scores in the repair group [N=53, median: 97, range: 58-100] compared to the QPA group
[N=10, median: 94, range: 32-100].
Conclusion: Failure rate and joint laxity measures were significantly increased in the internal brace repair group
relative to the QPA group. Failure-free survival in the repair group was less than 50% at two years.The high failure
rate in the repair group should be considered when selecting the appropriate intervention for the pediatric
adolescent athlete with an ACL injury.
The Orthopaedic Journal of Sports Medicine, 6(7)(suppl 4)
©The Author(s) 2018