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Published on: March 26, 2015
Pre-pubescent posterior cruciate ligament (PCL) reconstruction using maternal allograft
Nishith Shah1, Reetadyuti Mukhopadhyay2, Rohan Vakta1
1Aash Arthroscopy Centre, Ahmadabad, Gujarat, India.
Insights
Maternal allografts show promise for pediatric posterior cruciate ligament reconstruction, yielding excellent functional outcomes and graft acceptance in a small case series. Further research with larger cohorts and longer follow-up is recommended.
Area of Science:
- Orthopedic surgery
- Pediatric sports medicine
- Regenerative medicine
Background:
- Posterior cruciate ligament (PCL) reconstruction in children presents unique challenges due to open physes and graft source limitations.
- Traditional graft options like hamstring or bone-patellar tendon-bone are often unsuitable for pediatric patients.
Observation:
- This study evaluated maternal allografts for PCL reconstruction in three pre-pubescent children (ages 3.5, 7, and 10 years).
- Follow-up ranged from 7 to 9 years, with one patient lost to follow-up.
Findings:
- All patients demonstrated excellent functional improvements, with significant increases in IKDC Pedi and Lysholm scores.
- Post-operative assessments revealed no PCL laxity, and all grafts were well-tolerated without rejection or adverse tissue reactions.
Implications:
- Maternal allografts represent a viable alternative for pediatric PCL reconstruction, offering good functional recovery and graft integration.
- Larger studies and extended follow-up are necessary to confirm the long-term efficacy and safety of this technique until physeal closure.
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.
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