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

Veronica Beltran,Adriana S Conrad-Forrest,Tishya L Wren,Curtis D Vandenberg,Mia J Katzel

doi:10.3390/ijerph18147492

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.

Highlights

Introduction published maps and institutional affilAnterior cruciate ligament reconstruction (ACLR) is increasingly common in pediatric athletes [1,2]
We have previously shown that pediatric patients reconstructed with patellar tendon or quadriceps tendon autografts demonstrate greater biomechanical deficiencies during the rehabilitation phase than those reconstructed with hamstring tendon autografts [23]
Sex (p = 0.03) and age (p < 0.001) differed significantly among graft types with the iliotibial band (IT) group being younger with a higher percentage of males and the patellar tendon (PT) group being older than the other groups (Table 1)

Summary

Introduction

Anterior cruciate ligament reconstruction (ACLR) is increasingly common in pediatric athletes [1,2]. Treatment is individualized considering a patient’s age, current status, and future goals. Surgical decisions including graft selection, tunnel placement, graft tension, and fixation technique are made to optimize surgical outcomes [4]. These surgical decisions aim to restore pre-injury function, avoid growth disturbances, minimize the risk of future non-contact injury One important decision in ACLR is selection of graft type. Graft selection for pediatric ACLR is typically based on surgeon preference, physical maturity status of the patient, and post-surgical goals of the athlete

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