Abstract
Background:
The goal of skeletally immature ACL reconstruction is to restore function while minimizing graft failure and growth alteration. The reported high graft failure risk in pediatric patients merits consideration for concurrent lateral tenodesis. The purpose of this study was to evaluate outcomes following a single iliotibial band (ITB) graft combining extra-physeal femoral and trans-physeal tibial reconstruction with concurrent lateral tenodesis for the treatment of ACL tears in pediatric patients.
Hypothesis:
Hybrid ITB ACLR reconstruction will demonstrate a high graft survival rate, excellent patient reported outcome measures (PROMs), and no growth disturbances.
Methods:
An IRB-approved retrospective review of patients treated by two pediatric orthopedic surgeons between 2007 and 2023 identified 32 knees treated with a Hybrid ITB ACLR. The uniform surgical technique throughout the series consisted of a Hybrid ITB ACLR as a modification of the traditional Modified MacIntosh ITB ACLR: 80% ITB width utilized and passed lateral to medial over the posterior-lateral capsular fold and around the lateral femoral condyle, and anchored within an anatomically positioned trans-physeal tibial tunnel (6-7mm) with metaphyseal bio-interference screw fixation. 28 knees (88%) met the minimum two-year follow-up criterion. Exam, operative data, pre- and post-operative radiographic imaging, complications, and re-operations were recorded. Pediatric International Documentation Committee (Pedi-IKDC) and HSS Pediatric Functional Activity Brief Scale (Pedi-FABS) PROMs were assessed.
Results:
28 knees were evaluated at an average of 3.3 years post-operatively (2-12 years). At surgery, average age was 12.43±1.10 years, 19 (68%) were Sanders Bone age <3, and 23 (82%) were male. There was no clinical angular deformity or recurvatum noted at final follow-up. Coronal alignment (n=15) exhibited no change in mechanical axis zones pre- and post-operatively. Tibial slope (n=16) at final follow up was unchanged (pre=11.44±3.44 vs. post=10.31± 3.42; p=0.070). PROMs at final follow-up demonstrated excellent knee function and high activity levels. Pedi-IKDC averaged 94.5±6.95 (81.5-100; n=25) and Pedi-FABS averaged 24.2±4.96 (14-30; n= 26). 1 (3.6%) knee had graft failure at 10.5 months requiring reoperation. There were no other re-operations for meniscal or other associated pathology. (Figure 1)
Conclusion:
Hybrid ITB ACLR resulted in 96% graft survival at an average of 3.3-years post-operatively with excellent PROMs and no growth disturbance in a peri-pubescent population. Examination of safety in a younger pediatric population and anterior tibial translation control in the setting of anatomic tibial graft positioning in this modification of the ITB ACLR merits further study.
