Comparison of Revision ACL Reconstruction Using Iliotibial Band Augmented With Allograft Versus Bone–Patellar Tendon–Bone Autograft With Lateral Extra-articular Tenodesis

Abstract

Background: Bone–patellar tendon–bone (BTB) anterior cruciate ligament reconstruction (ACLR) is one of the conventional techniques in the revision setting especially after a primary hamstring tendon graft. The use of the iliotibial band (ITB) augmented with allograft (AG) is an encouraging graft alternative for ACLR in terms of clinical and biomechanical data in the literature. Purpose: To compare the clinical outcomes of BTB graft with lateral extra-articular tenodesis, modified Lemaire (BTB-LET), and an ITB graft augmented with hamstring AG (ITB-AG) in the setting of revision ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Descriptive data and clinical outcomes were prospectively collected from patients who underwent revision ACLR with either the BTB-LET or ITB-AG technique between 2012 and 2020 and who had a minimum follow-up of 2 years. The clinical outcomes were assessed by the Lysholm, Tegner, Anterior Cruciate Ligament–Return to Sport after Injury, International Knee Documentation Committee subjective knee evaluation form, and Knee injury and Osteoarthritis Outcome Score. Return to sports, complications, and revisions were also analyzed. Results: A total of 167 patients were included, with 106 patients in the BTB-LET group and 61 patients in the ITB-AG group. There were no significant group differences in sociodemographic characteristics; however, the mean follow-up was significantly longer in the BTB-LET compared with the ITB-AG group (52.0 vs 38.8 months, respectively; P = .0001). There were no significant differences in postoperative outcome scores; however, patients in the ITB-AG group had a higher rate of return to competitive pivoting sports (32.8% vs 17.9%; P = .0288) and a higher overall rate of return to preinjury sport (63.9% vs 47.2%; P = .0365). Complications, including revisions for meniscal or chondral lesions and retears (8 [8.3%] in the BTB-LET group and 2 [4.0%] in the ITB-AG group), were not significantly different. All retears were due to sports-related accidents. Conclusion: In this study, ITB-AG was not different from BTB-LET in terms of functional outcomes scores but allowed better return to sport rate. Performing ITB-AG reconstruction in the setting of revision ACLR appears to be safe, effective, and associated with a satisfying return-to-sports rate.

Donor age has no relevant role in biomechanical properties of allografts used in anterior cruciate ligament (ACL) reconstruction: A systematic review

“…The main finding of the present review was that donor age could not be considered to negatively influence the biomechanical properties of the allografts used in ACL reconstruction; although few studies reported a weak correlation of the age with the stress and the tensile strength of donor tissues. Given that, in the context of ACL revisions and, in some cases, even in primary reconstructions, allografts have mostly shown comparable results to autografts [1,2,18], and, based on the existing evidence, there are currently no contraindications to use allografts from donors over 40 years of age in these procedures.…”

“…Since no checklist is present to perform a quality appraisal for biomechanical studies assessing allograft properties, a five-item that regarded the study protocol was assessed, based on the arbitrary decision of the authors of this review. The items assessed were (1) Sample size of at least 50 specimens; (2) adequate setup description (with the description of testing protocol, machine used and graft preparation); (3) donor age role assessed as the primary outcome of the study; (4) consideration of confounding factor in the analysis (e.g., sex, irradiation, height); (5) evaluation of each type of allograft separately. For each item fulfilled, one point was assigned to the study.…”