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Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction: a 15-year prospective randomized controlled trial

Abstract

Purpose

The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi-ligament reconstruction. The purpose is to assess whether the ITB autograft is a long-term reliable alternative to the bone-patella-tendon-bone (BPTB) autograft, using a prospective randomized controlled trial design.

Methods

From 1995 to 1996, sixty patients scheduled for primary ACL reconstruction were included in a prospective randomized controlled trial. Three senior knee surgeons, experienced in both types of ACL surgery, performed all the operations. A standardized and supervised rehabilitation programme was used for both groups for 6 months. Thirty patients received the ITB reconstruction, and 30 received the BPTB reconstruction. Forty-nine participated at follow-up in 2010 (82 %). Primary outcome was the failure rate after ACL reconstruction. Secondary outcomes were knee injury osteoarthritis outcome score (KOOS) [pain, symptoms, Sport/Rec, quality of life (QOL), daily living function], Tegner activity scale, anterior knee pain-score, Lysholm score, Rolimeter laxity, extension deficit, single hop and crossover hop for distance.

Results

At 15-year follow-up, no significant difference existed between the groups. Graft failure occurred in 4 ITB subjects (16 %) and 3 BPTB subjects (13 %). KOOS (Sport/Rec) for the ITB group was 75 and 73 for the BPTB group. The KOOS (QOL) was 72 and 68 for the ITB group and BPTB group, respectively.

Conclusion

Similar graft failure rates and KOOS were found when comparing ITB- and BPTB-operated individuals, at 15-year follow-up. The ITB graft had equal long-term clinical results compared to the BPTB graft and is recommended as a reliable alternative autograft for ACL reconstruction.

Level of evidence

Therapeutic studies, Level I.

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References

  1. Ageberg E, Roos HP, Silbernagel KG, Thomee R, Roos EM (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17:162–169

    PubMed  Article  Google Scholar 

  2. Allum R (2003) Complications of arthroscopic reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 85:12–16

    PubMed  Article  Google Scholar 

  3. Bak K, Jorgensen U, Ekstrand J, Scavenius M (2001) Reconstruction of anterior cruciate ligament deficient knees in soccer players with an iliotibial band autograft. A prospective study of 132 reconstructed knees followed for 4 (2–7) years. Scand J Med Sci Sports 11:16–22

    CAS  PubMed  Article  Google Scholar 

  4. Bak K, Jorgensen U, Ekstrand J, Scavenius M (1999) Results of reconstruction of acute ruptures of the anterior cruciate ligament with an iliotibial band autograft. Knee Surg Sports Traumatol Arthrosc 7:111–117

    CAS  PubMed  Article  Google Scholar 

  5. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:890–897

    PubMed  Article  Google Scholar 

  6. Christel P, Djian P (2002) Anterio-lateral extra-articular tenodesis of the knee using a short strip of fascia lata. Rev Chir Orthop Reparatrice Appar Mot 88:508–513

    CAS  PubMed  Google Scholar 

  7. Comins J, Brodersen J, Krogsgaard M, Beyer N (2008) Rasch analysis of the knee injury and osteoarthritis outcome score (KOOS): a statistical re-evaluation. Scand J Med Sci Sports 18:336–345

    CAS  PubMed  Article  Google Scholar 

  8. Delcroix GJ, Kaimrajh DN, Baria D, Cooper S, Reiner T, Latta L, D’Ippolito G, Schiller PC, Temple HT (2013). Histological, biomechanical, and biological evaluation of fan-folded iliotibial band allografts for anterior cruciate ligament reconstruction. Arthroscopy 29:756–765

    PubMed  Article  Google Scholar 

  9. Engebretsen L, Lew WD, Lewis JL, Hunter RE (1990) The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med 18:169–176

    CAS  PubMed  Article  Google Scholar 

  10. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander JS (2010) A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 363:331–342

    CAS  PubMed  Article  Google Scholar 

  11. Ganko A, Engebretsen L, Ozer H (2000) The rolimeter: a new arthrometer compared with the KT-1000. Knee Surg Sports Traumatol Arthrosc 8:36–39

    CAS  PubMed  Article  Google Scholar 

  12. Goertzen M, Schulitz KP (1993) Comparison of combined extra- and intra-articular stabilization versus isolated arthroscopic semitendinosus repair after rupture of the anterior cruciate ligament. Sportverletz Sportschaden 7:7–12

    CAS  PubMed  Article  Google Scholar 

  13. Frank JS, Gambacorta PL (2013) Anterior cruciate ligament injuries in skeletally immature ahlete: diagnosis and management. J Am Acad Orthop Surg 2:78–87

    Article  Google Scholar 

  14. Heijne A, Werner S (2010) A 2-year follow-up of rehabilitation after ACL reconstruction using patellar tendon or hamstring tendon grafts: a prospective randomised outcome study. Knee Surg Sports Traumatol Arthrosc 18:805–813

    PubMed  Article  Google Scholar 

  15. Hey-Groves EW (1920) The crucial ligaments of the knee joint: their function, rupture, and operative treatment of the same. Br J Surg 7:505–515

    Article  Google Scholar 

  16. Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA (2011) Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for “isolated” anterior cruciate ligament tear. Am J Sports Med 39:89–98

    PubMed  Article  Google Scholar 

  17. Jorgensen U, Bak K, Ekstrand J, Scavenius M (2001) Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability. Knee Surg Sports Traumatol Arthrosc 9:137–145

    CAS  PubMed  Article  Google Scholar 

  18. Jorgensen U, Stahl-Otte K, Bak K (1998) ACL-reconstruction of the chronic unstable knee—bone-patella-tendon-bone versus iliotibial band autograft—a prospective randomised study with special focus on side effects. Acta Orthop Scand 69:52–53

    Google Scholar 

  19. Laxdal G, Sernert N, Ejerhed L, Karlsson J, Kartus JT (2007) A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients. Knee Surg Sports Traumatol Arthrosc 15:115–125

    PubMed  Article  Google Scholar 

  20. Lee GH, McCulloch P, Cole BJ, Bush-Joseph CA, Bach BR Jr (2008) The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy 24:162–166

    PubMed  Article  Google Scholar 

  21. Li S, Su W, Zhao J et al (2011) A meta-analysis of hamstring autografts versus bone-patellar tendon-bone autografts for reconstruction of the anterior cruciate ligament. Knee 18:287–293

    PubMed  Article  Google Scholar 

  22. Liden M, Ejerhed L, Sernert N, Laxdal G, Kartus J (2007) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-year follow-up. Am J Sports Med 35:740–748

    PubMed  Article  Google Scholar 

  23. Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P (2010) Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med 38:1094–1102

    PubMed  Article  Google Scholar 

  24. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    PubMed  Article  Google Scholar 

  25. Poulsen M, Fabrin J, Carstensen JP, Ulnits L, Lausten GS (2003) Reconstruction of anterior cruciate ligament using bone-patellar tendon-borne graft or fascia lata graft. A retrospective study of functional results. Ugeskr Laeger 165:682–685

    PubMed  Google Scholar 

  26. Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR (2007) Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 87:337–349

    PubMed  Article  Google Scholar 

  27. Risberg MA, Lewek M, Snyder-Mackler L (2004) A systematic review of evidence for anterior cruciate ligament rehabilitation: how much and what type. Phys Ther Sport 5:125–145

    Article  Google Scholar 

  28. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    CAS  PubMed  Article  Google Scholar 

  29. Rubinstein RA Jr, Shelbourne KD, VanMeter CD, McCarroll JC, Rettig AC (1994) Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med 22:324–327

    PubMed  Article  Google Scholar 

  30. Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K (2011) Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial. Am J Sports Med 39:2161–2169

    PubMed  Article  Google Scholar 

  31. Salmon LJ, Russell VJ, Refshauge K et al (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34:721–732

    PubMed  Article  Google Scholar 

  32. Schlegel TF, Boublik M, Hawkins RJ, Steadman JR (2002) Reliability of heel-height measurement for documenting knee extension deficits. Am J Sports Med 30:479–482

    PubMed  Google Scholar 

  33. Schoderbek RJ Jr, Treme GP, Miller MD (2007) Bone-patella tendon-bone autograft anterior cruciate ligament reconstruction. Clin Sports Med 26:525–547

    PubMed  Article  Google Scholar 

  34. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE Jr (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32:1986–1995

    PubMed  Article  Google Scholar 

  35. Suero EM, Njoku IU, Voigt MR, Lin J, Koenig D, Pearle AD (2012). The role of the iliotibial band during the pivot shift test. Knee Surg Sports Traumatol Arthrosc

  36. von Porat A, Roos EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273

    Article  Google Scholar 

  37. Wilson WJ, Scranton PE Jr (1990) Combined reconstruction of the anterior cruciate ligament in competitive athletes. J Bone Joint Surg Am 72:742–748

    CAS  PubMed  Google Scholar 

  38. Yamaguchi S, Sasho T, Tsuchiya A, Wada Y, Moriya H (2006) Long term results of anterior cruciate ligament reconstruction with iliotibial tract: 6-, 13-, and 24-year longitudinal follow-up. Knee Surg Sports Traumatol Arthrosc 14:1094–1100

    PubMed  Article  Google Scholar 

  39. Yamamoto Y, Hsu WH, Van Fisk JA, Scyoc AH, Miura K, Woo SL (2006) Effect of the iliotibial ban on knee biomechanics during a simulated pivot shift test. J Orthop Res 5:967–973

    Article  Google Scholar 

  40. Zebis MK, Andersen LL, Bencke J, Kjaer M, Aagaard P (2009) Identification of athletes at future risk of anterior cruciate ligament ruptures by neuromuscular screening. Am J Sports Med 37:1967–1973

    PubMed  Article  Google Scholar 

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Acknowledgments

The authors extend special thanks to Lise Ellerø, Natasha Kiss and Camilla Quist Larnkjær for collecting the data at follow-up. Thanks also extend to Tom Nicolaisen for reading the manuscript and providing useful comments.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Frederik Stensbirk.

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Stensbirk, F., Thorborg, K., Konradsen, L. et al. Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction: a 15-year prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 22, 2094–2101 (2014). https://doi.org/10.1007/s00167-013-2630-9

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  • DOI: https://doi.org/10.1007/s00167-013-2630-9

Keywords

  • ACL reconstruction
  • Patellar ligament
  • Iliotibial band
  • KOOS
  • Long term