Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

Abstract

Iliotibial band autograft is an increasingly popular option for pediatric anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare recovery of knee extensor mechanism function among pediatric patients who underwent ACLR using iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), and patellar tendon (PT) autografts. One hundred forty-five pediatric athletes (76 female; age 15.0, range 7–21 years) with recent (3–18 months) unilateral ACLR performed drop-jump landing and 45° cutting with 3D motion capture. Knee extensor mechanism function (maximum knee flexion angle, maximum internal knee extensor moment, energy absorption at knee) during the loading phase (foot contact to peak knee flexion) was compared among graft types (20 IT, 29 HT, 39 QT, 57 PT) and sides (ACLR or contralateral) using linear mixed models with sex, age, and time since surgery as covariates. Overall, knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during both tasks (p < 0.03). All graft types exhibited lower knee extensor moments and energy absorption on the operated side during both movements (p ≤ 0.001). Kinetic asymmetry was significantly lower for IT compared with QT and PT during both movements (p ≤ 0.005), and similar patterns were observed for HT vs. QT and PT (p ≤ 0.07). Asymmetry was similar between IT and HT and between QT and PT. This study found that knee extensor mechanism function recovers fastest in pediatric ACLR patients with IT autografts, followed by HT, in comparison to QT and PT, suggesting that IT is a viable option for returning young athletes to play after ACLR.

Limited evidence for graft selection in pediatric ACL reconstruction: a narrative review

“…A recent retrospective study by Wren et al (2021) evaluated knee extensor function post-ACLR in pediatric patients ( n = 145) receiving ITB, BPTB, HT or QT autografts. Patients included in the studied were aging between 7 and 21 years old [ 53 ]. As hypothesized by the authors, knee extensor function recovery was significantly greater in patients receiving autografts that do not disrupt the knee extensor mechanism, being the ITB and HT autografts [ 53 ].…”

“…Patients included in the studied were aging between 7 and 21 years old [ 53 ]. As hypothesized by the authors, knee extensor function recovery was significantly greater in patients receiving autografts that do not disrupt the knee extensor mechanism, being the ITB and HT autografts [ 53 ]. Patients receiving an ITB autograft demonstrated higher knee flexion angles on the operated vs contralateral side during drop jump and cutting than all other patient groups [ 53 ].…”

“…Decreases in loading on the injured limb were noted in all four groups, but not evenly. The ITB group showed the slightest decrease, followed by the HT group, the QT group and finally, the BPTB group [ 53 ]. No between-group differences were observed regarding loading on the contralateral limb, which increased similarly in all four groups [ 53 ].…”

“…The ITB group showed the slightest decrease, followed by the HT group, the QT group and finally, the BPTB group [ 53 ]. No between-group differences were observed regarding loading on the contralateral limb, which increased similarly in all four groups [ 53 ]. The ITB group also showed significantly lower kinetic asymmetry at the lower limbs compared to both the QT and BPTB groups ( p ≤ 0.005) [ 53 ].…”

“…No between-group differences were observed regarding loading on the contralateral limb, which increased similarly in all four groups [ 53 ]. The ITB group also showed significantly lower kinetic asymmetry at the lower limbs compared to both the QT and BPTB groups ( p ≤ 0.005) [ 53 ]. The HT group showed similar results to the ITB group [ 53 ].…”