Clinical outcomes of quadrupled hamstring tendon use for anterior cruciate ligament reconstruction in the paediatric population: A systematic review

BACKGROUND: This study aimed to perform a systematic review to assess complication rates and clinical outcomes after use of quadrupled hamstring tendon graft for anterior cruciate ligament reconstruction (ACLR) in the paediatric population. METHODS: A systematic literature search was conducted following PRISMA guidelines and registered prospectively. Comparative and non-comparative studies that explicitly used quadrupled hamstring tendon for ACLR in skeletally immature patients were included. Patient-reported outcome measures, radiographic measurements and functional outcomes were reviewed. Quality assessment was performed using the Newcastle Ottawa Score. RESULTS: Thirty-four studies met the eligibility criteria with 1384 patients. The mean age was 13.5 years with 47.3 % males and mean follow up of 44.2 months. The overall complication rate was 14.2 %, graft failure was 6.5 % and revision surgery was 2.6 %. The mean postoperative Lysholm score was 93.0, the Tegner score was 7.3, and the IKDC score was 91.4. Return to activity was 88 %. The mean KT-1000 was 1.59 mm. The mean postoperative mLDFA was 91.0°, mMPTA was 87.2° and femorotibial angle was 2.59°. CONCLUSION: Quadrupled hamstring tendon graft in ACLR offers good to excellent patient reported outcomes and low incidence of growth arrest. The graft re-rupture rate is up to 6.5%.