Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2001-05, Vol.9 (3), p.137-145
• Main Authors: Jørgensen, U, Bak, K, Ekstrand, J, Scavenius, M
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Adult; Anterior Cruciate Ligament - surgery; Anterior cruciate ligament reconstruction; Arthralgia - etiology; Bone surgery; Cartilage - injuries; Chronic Disease; Fascia Lata - transplantation; Female; Follow-Up Studies; Hospitals; Humans; Iliotibial band; Injuries; Instability; Joint Instability - diagnosis; Joint Instability - therapy; Knee; Knee Injuries - physiopathology; Knee Injuries - therapy; Knee Joint - physiopathology; Knees; Knowledge; Lateral tenodesis; Ligaments; Male; Medial Collateral Ligament, Knee - injuries; MEDICIN; MEDICINE; Middle Aged; Orthopedics; Patient Satisfaction; Patients; Prospective Studies; Range of Motion, Articular; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Recovery of Function; Rupture; scoring; Sports; Stability; Surgery; Tendons; Tibial Meniscus Injuries; Transplantation, Autologous; Treatment Outcome
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1007/s001670000163

We performed combined internal and external anterior cruciate ligament (ACL) reconstruction with the iliotibial band autograft in 169 consecutive patients with chronic ACL insufficiency who were followed up for 24-61 months. Of these, 155 (91%) agreed to an additional independent observer follow-up after 24-92 months. Eight patients (5%) had sustained a rerupture/elongation of the graft and were operated on again; nine (6%) had sustained a tear of the contralateral ACL. Knee function and activity increased after the reconstruction. Lysholm scores improved from median 81 preoperatively to 99 at follow-up and Tegner scores from median 4 to 7. At follow-up 97 (71%) were active at the same level as prior to injury. In 17 of the 40 patients (12%) dropping to a lower activity level this was due to knee problems. The side-to-side difference in anterior-posterior knee laxity was more than 3 mm in 18 knees (13%) and more than 5 mm in 3 knees (2%). Including eight reruptures, this results in a "stability" failure rate of 8.8%. The overall IKCD rating showed normal knee function in 88 (73%) and nearly normal knee function in 30 (25%). Anterior knee pain was present in 14 (10%) of the patients at follow-up. Patients with isolated ACL injury had higher Lysholm scores and Tegner scores than patients with associated injuries. No clinical signs of varus knee development were seen. Of the 155 patients 94% would have the procedure repeated if necessary with the knowledge that they have today. The combined internal and external iliotibial band procedure can restore knee stability and function in the majority of chronic ACL-insufficient knees.