ArticleOrthopaedic journal of sports medicine2025
Biomechanical Comparison of ACL-R Using an Iliotibial Band Autograft Reinforcement and Bone-Patellar Tendon-Bone Graft With and Without Lateral Extra-articular Tenodesis.
Article in Orthopaedic journal of sports medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: An alternative single-bundle anatomic anterior cruciate ligament (ACL) reconstruction (ACL-R) devised by the senior author comprised an anterolateral reinforcement using an iliotibial band (ITB) autograft. The knee biomechanics of this technique have not been compared with standard ACL-R methods. Purpose: To compare the knee kinematics of ACL-R using bone-patellar-tendon bone graft with lateral extra-articular tenodesis (BTB+LET) versus ITB ACL-R with anterolateral reinforcement. Study Design: Controlled laboratory study. Methods: A total of 20 unpaired fresh-frozen human cadaveric knees (mean age, 41.4 years) were tested using a robotic system under 3 loads: (1) 89-N anterior tibial (AT) load (at 0°-90° of flexion); (2) 5-Nm internal rotation (IR) tibial torque (0°-90° of flexion); and (3) a simulated pivot-shift (PS) load, as a combined 7-Nm valgus moment and 5-Nm IR torque (at 0°, 15°, and 30° of flexion). All knees were tested with the ACL intact; one ACL-R group (n = 10) was tested with ITB reconstruction, and the other group (n = 10) was tested with BTB graft reconstruction, both with (BTB+LET) and without a LET procedure. Results: Significantly less AT translation, IR, and tibial displacement during simulated PS were detected at all knee flexion angles in the ITB, BTB, and BTB+LET states compared with the ACL-deficient state ( Conclusion: BTB and ITB ACL-R both improved knee stability compared with the ACL-deficient state in response to AT, IR, and simulated PS loading; however, no method restored the intact ACL behavior. BTB+LET caused overconstraint at 15° of knee flexion during simulated PS loading. Clinical Relevance: ITB ACL-R provides an alternative technique to improve stability of the ACL-deficient knee.
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