Reconstruction of anterior cruciate ligament deficient knees in soccer players with an iliotibial band autograft

Abstract

One hundred and thirty-two consecutive soccer players (117 males and 15 females, median age 23, range 16-39 years) underwent primary reconstruction of the anterior cruciate ligament (ACL) with an iliotibial band (ITB) autograft. All patients were followed prospectively for a minimum of 2 years. One hundred and eighteen patients (89%) attended an independent observer follow-up after a median of 47 (24-92) months. The time before participating in soccer was a median of 7 (5-24) months. At a median of 4 years, 80 (68%) were still active soccer players, while 38 had changed activity to a lower level. Twenty-five gave up soccer playing for reasons unrelated to the knee, and 13 (11%) gave up due to problems from the reconstructed knee. The Lysholm score improved from a median of 82 (range 42-99, mean [SD] 80.5 [+/-11.9]) points prior to the operation to a median of 99 (range 57-100, mean [SD] 94.6 [+/-8.5]) at follow-up. The Tegner score improved from a median of 3.5 (0-7) preoperatively to 9 (1-10). Four patients (3%) sustained a rupture of the graft: three ruptures occurred among the 15 females (20%), and one was seen among the 117 males (0.8%) (P=0.01). Eight per cent had predominantly minor cosmetic complaints from the donor-site hernia, while 51% had temporary discomfort from the staples used for graft fixation. Using the ITB autograft for ACL reconstruction, we found excellent and good results in soccer players with ACL deficiency and high demands for optimal knee function. The failure rate in general was comparable with other methods, and the majority was still active in soccer sports at a median of 4 years after surgery. An unacceptably high rerupture rate was registered in female players.

Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play

“…Nine studies reported a mean time between surgery and the resumption of sport of 7.3 (range 2–24) months 50 52 53 66 68 69 71 76 77. The level of sports participation resumed varied among these studies with the time to return to the preinjury sports level, time to return to preoperative sports level, time to resume competition at full capacity, time to resume full physical activity and time to resume sport variously reported.…”

“…The level of sports participation resumed varied among these studies with the time to return to the preinjury sports level, time to return to preoperative sports level, time to resume competition at full capacity, time to resume full physical activity and time to resume sport variously reported. Three studies reported a mean time between surgery and resumption of training or sport-specific activity of 4.1 (range 1–24) months 53 68 71. Daniel et al 5 reported the number of hours of sports participation per person per year, and compared preinjury with postoperative participation.…”

“…Seventeen studies reported mean anterior tibial translation,5 13 44 48 52 55 56 59–61 68 71 73 74 77–79 with a combined group mean of 1.7 mm side-to-side difference. When the results of the other 20 studies10 45–48 50 51 54 58 62–65 69 70 80–84 were pooled, it was found that 91% of patients had a side-to-side difference in anterior tibial translation of ≤5 mm at final follow-up.…”

“…Twenty-five studies used the IKDC classification to evaluate the functional status of patients' knees at final follow-up 13 26 46 47 50 51 53 54 58–60 62 63 65 68 69 71 74 76 78–82 84. Eighty-five per cent of patients were reported to have a normal or nearly normal knee (IKDC category A or B).…”

Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test

“…Thus, the donor site morbidity from harvest of the ITB for an ACL graft should be considered, as it might diminish the stability of ACL reconstructed knees in response to rotatory load. 28 Further research is suggested to understand in vivo forces of the ITB and to investigate the effects of other muscles of the lower extremity during a pivot shift test of a patient who is conscious. 29,30 …”