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Iliotibial band autograft is a suitable alternative graft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite encouraging clinical, biomechanical and histological results, ACL reconstruction using the ITB was slowly abandoned. The hypothesis was that the current literature supports the use of ITB as the graft of choice for ACL reconstruction because of its good outcomes.

Methods

A systematic search of the literature was performed in the PubMed, MEDLINE, Cochrane, and Ovid databases to identify published clinical studies relevant to ACL reconstruction with ITB autograft and studies comparing ITB autograft with bone–patellar tendon–bone (BPTB) and hamstring (HT) autografts (none were found). The results of the eligible studies were analyzed in terms of graft failure, instrumented knee laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, Tegner activity score, return to sports rate, return to sports at pre-injury level and complications.

Results

Nineteen clinical studies including 1,210 patients with ACL reconstruction met the inclusion criteria. Graft failure occurred after ITB autograft in 4.2% of patients. Postoperative mean side-to-side laxity was 1.41 mm with 21% of patients having greater than 3 mm side-to-side difference. Lachman test and pivot-shift test were negative (grade 0) in 57% and 85%, respectively, and were grade 0 or 1 in 95% and 97%, respectively. Functional outcomes were satisfactory in 84% of patients with good to excellent results (Lysholm score > 84). Mean postoperative Lysholm score was 93.3 and 84% of patients had an objective IKDC grade of A or B. Mean postoperative Tegner score was 6.8. The return to sports rate was 89% and 61% of patients returned to their pre-injury level. A comparison of 89 ITB versus 80 BPTB autografts revealed no significant differences in graft failure (n.s.), instrumented mean side-to-side knee laxity difference (n.s.) or Tegner score (n.s.).

Conclusion

The graft survival rate and clinical and functional outcomes for ITB autograft are satisfactory. By allowing ACL reconstruction and lateral tenodesis to be done with a single, continuous, pedicled graft through an outside-in femoral tunnel, this technique may become the preferred alternative for primary or secondary ACL surgery.

Level of evidence

Level IV

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Abbreviations

ACL:

Anterior cruciate ligament

BPTB:

Bone–patellar tendon–bone

CI:

Confidence intervals

CMS:

Coleman methodological score

HT:

Hamstring

IKDC:

International knee documentation committee

ITB:

Iliotibial band

LCL:

Lateral collateral ligament

MCMS:

Modified Coleman methodological score

n.s.:

Non-significant

OCEBM:

Oxford centre for evidence-based medicine

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

QT:

Quadriceps tendon

ROM:

Range of motion

SD:

Standard deviation

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France

    Thibaut Lucena, Vincent Marot, Louis Courtot & Etienne Cavaignac

  2. Clinique Rive Gauche, Toulouse, France

    Marie Cavaignac

  3. Institut de Chirurgie Orthopédique Et Sportive À Strasbourg (ICOSS), Strasbourg, France

    Christian Lutz

  4. Department of Epidemiology, Health Economics and Public Health, INSERM-University of Toulouse III, Toulouse University Hospital, UMR1027, Toulouse, France

    Emilie Bérard

  5. I2R – Institut de Recherche Riquet, Toulouse, France

    Etienne Cavaignac

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  1. Thibaut Lucena
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  3. Vincent Marot
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  4. Louis Courtot
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  5. Christian Lutz
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  7. Etienne Cavaignac
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Contributions

TL participated in the design of the study, performed data collection and drafted the manuscript. VM helped to draft the manuscript. LC helped to performed data collection. CL performed a critical review of manuscript. EB performed the statistical analysis. NR performed a critical review of manuscript. EC devised the study and participated in its design and coordination. All authors read and approved the final manuscript.

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Correspondence to Etienne Cavaignac.

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Lucena, T., Cavaignac, M., Marot, V. et al. Iliotibial band autograft is a suitable alternative graft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 30, 1679–1690 (2022). https://doi.org/10.1007/s00167-021-06701-w

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