KSSTA - 2026-08-17 - Journal Article
Hamstring graft remodelling after ACL reconstruction is slower in paediatric population compared to adults.
de Pesters C, Vari N, Bérard E, Maupoint E, Staali L, Faruch M, Cavaignac E, Accadbled F
Topics
Key Takeaway
At 12 months post-ACLR with ST4 hamstring autograft, pediatric patients had a mean adjusted SNQ of 5.1 versus 1.5 in adults (p<0.001), indicating significantly slower graft remodelling.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This single-centre pilot study compared MRI-based hamstring graft maturation at 12 months between paediatric and adult ACLR patients using SNQ and Howell scoring. Paediatric patients demonstrated significantly higher mean adjusted SNQ (5.1 vs. 1.5, p<0.001) and a predominance of Howell Grade II, confirming less mature grafts at one year. Tibial tunnel widening rates and PROMs were comparable between groups, isolating graft signal intensity as the differentiating variable.
Key Limitation
As a pilot study with n=52 paediatric patients and a single 12-month MRI assessment, the study cannot define the timepoint at which paediatric graft SNQ normalises to adult levels, which is the clinically actionable endpoint.
Original Abstract
PURPOSE
Anterior cruciate ligament (ACL) injuries are increasing in children and adolescents and reconstruction (ACLR) is now frequently performed in this population. Paediatric patients remain at higher risk of reinjury, possibly due to delayed graft remodelling. The current study aims to compare magnetic resonance imaging (MRI)-based graft remodelling between paediatric and adult populations at 1 year postoperatively.
METHODS
We conducted a single-centre comparative pilot study including a prospectively collected cohort of 52 paediatric and 59 adult patients undergoing ACLR with a semitendinosus autograft folded in four (ST4) without additional lateral extra-articular tenodesis (LET). MRI was performed at 12 months postoperatively. Graft maturation was assessed using the signal-to-noise quotient (SNQ) and Howell scores. Tibial tunnel widening (TTW) and patient-reported outcome measures (PROMs) were also collected.
RESULTS
The mean adjusted SNQ was significantly higher (p < 0.001) in paediatric patients (5.1; 95% confidence interval [CI] [4.3-5.9]) than in adults (1.5; 95% CI [0.9-2.2]), indicating slower remodelling. The Howell classification confirmed less mature grafts in children, with a predominance of Grade II. TTW was observed in similar proportions in both groups. PROMs were favourable and comparable in both groups. One paediatric patient experienced a graft rupture at 6 months, following premature return to pivoting sport.
CONCLUSION
At 1-year post-ACLR, paediatric patients show delayed graft remodelling compared to adults. This slower biological incorporation may contribute to higher reinjury rates in young athletes and supports the need for prolonged rehabilitation and careful return to high-risk sports.
LEVEL OF EVIDENCE
Level II.