Double iliotibial tract autograft for ACL reconstruction: A clinical prospective pilot study
Author(s):
Munch D. (Denmark)
,
Munch D. (Denmark)
Affiliations:
Konradsen L.
,
Konradsen L.
Affiliations:
Eljaja S.
Eljaja S.
Affiliations:
ESSKA Academy. Munch D. 05/09/18; 209519; P07-632 Topic: Arthroscopic Surgery
Mr. Daniel K. Munch
Mr. Daniel K. Munch
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Abstract
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Objectives: In the 1980s part of the iliotibial tract (ITB) was popular as a graft for ACL reconstructions especially in the Scandinavian countries. In the mid-1990s first the BPTB graft and then the ST/G graft became all dominant even though the few studies reporting on the results of the ITB graft reconstructions were favorable. However, from a mechanical point of view, the graft was considered too weak to withstand ACL stresses. With the development of newer fixation techniques, we devised an operative technique that could provide sufficient mechanical graft strength. Furthermore, it could be seen as a functional advantage that neither the hamstring function nor the extensor mechanism of the knee was hampered by graft harvesting. Finally, the lateral ITB tenodesis could provide an ALL function to the reconstruction.

The objectives of this pilot study were to test if the mechanical and functional results of ACL reconstructions with double ITB grafts are comparable to other reconstruction techniques with special emphasis on graft donor-site complications.

Methods: Clinical prospective cohort study. Ten patients (4 females, 6 males), median age 25 (20-40 years) who underwent ACL reconstruction with a double ITB graft from July 2014 - March 2015. Preoperative and at 1-year and 2-years follow-up patients were mechanically examined, performed functional tests, and completed the KOOS and Tegner scores. Furthermore, grade of satisfaction and donor site complications were recorded.

Results: 2-year post-op, no re-rupture had occurred. Instrumented Lachmann test showed significant improvement in mean side difference: pre-op: 3,3 mm [±1,33]; 2 years post-op: 1,9 mm [±1,1] (p=0.005).
One patient had a pivot shift grade 1 (glide).
Functionally, all ten patients reached LSI>90 (Limb Symmetry Index). Tegner score increased from mean 2,8 pre-OP to 6,4 post-OP (p<0,001). None did however reach pre-injury Tegner score or sports level. KOOS was increased significantly in four of the five subscales.
One patient experienced cosmetic inconveniences, another pain from the lateral muscle herniation. All ten patients were either satisfied or very satisfied and would have the reconstruction performed again if they had the option.

Conclusions: In a pilot study, the double ITB autograft ACL reconstruction showed mechanical stability results and functional outcomes comparable to standard reconstruction methods. However, cosmetic inconvenience and donor site pain was reported in 1 out of 10 patients.

Based on these outcomes we have started an RCT comparing this method of reconstruction to other well-established reconstruction methods.

Keywords:
ACL reconstruction; iliotibial tract autograft
Objectives: In the 1980s part of the iliotibial tract (ITB) was popular as a graft for ACL reconstructions especially in the Scandinavian countries. In the mid-1990s first the BPTB graft and then the ST/G graft became all dominant even though the few studies reporting on the results of the ITB graft reconstructions were favorable. However, from a mechanical point of view, the graft was considered too weak to withstand ACL stresses. With the development of newer fixation techniques, we devised an operative technique that could provide sufficient mechanical graft strength. Furthermore, it could be seen as a functional advantage that neither the hamstring function nor the extensor mechanism of the knee was hampered by graft harvesting. Finally, the lateral ITB tenodesis could provide an ALL function to the reconstruction.

The objectives of this pilot study were to test if the mechanical and functional results of ACL reconstructions with double ITB grafts are comparable to other reconstruction techniques with special emphasis on graft donor-site complications.

Methods: Clinical prospective cohort study. Ten patients (4 females, 6 males), median age 25 (20-40 years) who underwent ACL reconstruction with a double ITB graft from July 2014 - March 2015. Preoperative and at 1-year and 2-years follow-up patients were mechanically examined, performed functional tests, and completed the KOOS and Tegner scores. Furthermore, grade of satisfaction and donor site complications were recorded.

Results: 2-year post-op, no re-rupture had occurred. Instrumented Lachmann test showed significant improvement in mean side difference: pre-op: 3,3 mm [±1,33]; 2 years post-op: 1,9 mm [±1,1] (p=0.005).
One patient had a pivot shift grade 1 (glide).
Functionally, all ten patients reached LSI>90 (Limb Symmetry Index). Tegner score increased from mean 2,8 pre-OP to 6,4 post-OP (p<0,001). None did however reach pre-injury Tegner score or sports level. KOOS was increased significantly in four of the five subscales.
One patient experienced cosmetic inconveniences, another pain from the lateral muscle herniation. All ten patients were either satisfied or very satisfied and would have the reconstruction performed again if they had the option.

Conclusions: In a pilot study, the double ITB autograft ACL reconstruction showed mechanical stability results and functional outcomes comparable to standard reconstruction methods. However, cosmetic inconvenience and donor site pain was reported in 1 out of 10 patients.

Based on these outcomes we have started an RCT comparing this method of reconstruction to other well-established reconstruction methods.

Keywords:
ACL reconstruction; iliotibial tract autograft
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