Grant: Project Grant

Injuries to the anterior cruciate ligament (ACL) - one of the key ligaments that helps stabilize the knee - occur in approximately 200,000 US people per year, with its cost of treatment exceeding $1 Billion USD annually. These injuries often occur in adolescents and are treated with surgery. Part of this surgery involves taking tendon tissue (known as a graft) from the patient to replace their torn ACL. However, despite improvements in available techniques and technology, as much as 1 in 4 active pediatric patients may experience a surgical failure; with those under 18 years being 15 times more likely to re-injure their graft within the first year after surgery. Most recommend young patients with ACL injuries use their own tissue for the graft given they are still growing. Currently, grafts from the hamstrings are the standard of care; however, there is renewed interest in using grafts from the quadriceps, due a combination of its increased strength, less kneeling pain and problems from the graft site, and comparable outcomes to the hamstring graft. Based on our successful pilot study of 100 patients aged 10-18 years, we have shown that a large-scale, definitive randomized controlled trial is feasible to evaluate the effect of hamstring and quadriceps grafts in ACL reconstruction on graft failure rate, rate of return-to-sport, knee function, knee pain, range of motion and stability, and any complications (such as another surgery) at 2 years. Given that the use of either graft involves the same fixation devices, intraoperative equipment, surgical time, and rehabilitation protocols; the use of a new and potentially superior quadriceps tendon as a graft has tremendous potential benefit with no additional costs to patients or the healthcare system.