Pre-pubescent posterior cruciate ligament (PCL) reconstruction using maternal allograft.

PURPOSE: Posterior cruciate ligament (PCL) reconstruction is a challenge in the pre-pubescent and paediatric age group. It requires great skill in tunnel and graft placement and fixation through open physes. Another major concern is the source of graft, as the thickness of harvested hamstring graft is unpredictable in children and the bone patella tendon bone graft cannot be used due to un-ossified patella and tibial tuberosity. Quadriceps being an important agonist of PCL, we decided not to use it as a graft source.

METHODS

PCL reconstruction was done in three pre-pubescent children aged 3.5, 7 and 10 years using maternal allograft with follow-up of 7, 9 and 7 years (the 10-year-old boy was lost to follow-up after 2013), respectively.

RESULTS

All the patients showed excellent results with the median IKDC Pedi improving to 90 (85-92) at latest follow-up as against 29.9 (25-35) pre-operatively. The median Lysholm score improved from 45 (42-47) to 100 (95-100). The posterior drawer test showed no PCL laxity during the latest follow-up. The grafts were accepted well by all three with no evidence of graft rejection or tissue reaction.

CONCLUSION

Living donor allografts may be a good option for paediatric ligament reconstruction. This, however, must be supported with more evidence from a larger study group and a longer follow-up until the closure of physes.

LEVEL OF EVIDENCE: IV.