Clinical Outcomes of ACL Reconstruction using a Physical-Sparing Technique with Iliotibial Band Autograft in Skeletally Immature Children
Presenter Status
Medical Student
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Dr. Ryan Koehler
Presentation Type
Poster
Start Date
21-5-2026 12:00 PM
End Date
21-5-2026 1:00 PM
Abstract Text
Background:
The iliotibial band (ITB) autograft has been a common choice for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients for decades. However, the long-term results remain unclear rendering controversy in the preferred surgery for these patients. Reinjuries may have detrimental effects on patients’ lives and pose a threat to the health of their joints. Boston Children’s Hospital (Kocher, et al.) and Children’s Orthopaedics of Atlanta (Willimon, et al.) published case series describing their outcomes for ACL reconstruction using ITB autografts, where both found this method to have favorable outcomes and durability.
Objectives/Goal:
To assess the long-term outcomes of ITB ACL reconstruction in skeletally immature patients at a single institution, with specific focus on rates of reinjury, graft failure, associated meniscal pathology, and need for revision surgery.
Methods/Design:
This was a retrospective case series. Using the ICD-10 code for ACL reconstruction, the electronic medical record at our institution was queried for patients who underwent ITB ACL reconstruction between 1/1/2004-12/31/2022. Through chart review, we evaluated patient demographics, average age and mechanism of injury, and additional injuries, and need for revision surgery.
Results:
117 patients, 14% female (16), 86% male (101) were included in the study. The average age at time of ITB ACL reconstruction was 12.0 years. 41 patients, or 35% of patients who underwent an ITB ACL reconstruction had a repeat injury event. Of the reinjured patients, 16 (or 39%) sustained an injury to the ITB graft, with a median time of 43.8 months post operatively. Of the patients with IT band graft injuries, 11 (68.8%) patients required return to OR for revision ACL reconstruction, 1 did not require revision, however, 4 (25%) were lost to follow up. Notably, 7 of the 16 patients who reinjured their ITB graft also sustained an injury to the medial meniscus, and 17 of 41 (41.4%) total reinjured patients sustained isolated medial meniscus tears. The average time from ITB ACLR to medial meniscus injury was 35.5 months. 5 patients had concomitant graft failures and lateral meniscus tears, and 7 of 41 (17%) reinjured patients had isolated lateral meniscus tears.
Conclusions:
While many patients demonstrated durability of the ITB ACL reconstruction, the rate of reinjury, specifically graft failure and medial meniscus tears, and need for revision ACL reconstruction is higher than previously published by other institutions, highlighting a potential deficit in the function of an ITB autograft the need for improved strategies to protect young athletes. While ITB ACL reconstruction has been regarded as a reliable and durable option for most, the rate of repeat injury and need for revision surgery in some should prompt careful consideration of surgical options by surgeons and families.
Clinical Outcomes of ACL Reconstruction using a Physical-Sparing Technique with Iliotibial Band Autograft in Skeletally Immature Children
Background:
The iliotibial band (ITB) autograft has been a common choice for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients for decades. However, the long-term results remain unclear rendering controversy in the preferred surgery for these patients. Reinjuries may have detrimental effects on patients’ lives and pose a threat to the health of their joints. Boston Children’s Hospital (Kocher, et al.) and Children’s Orthopaedics of Atlanta (Willimon, et al.) published case series describing their outcomes for ACL reconstruction using ITB autografts, where both found this method to have favorable outcomes and durability.
Objectives/Goal:
To assess the long-term outcomes of ITB ACL reconstruction in skeletally immature patients at a single institution, with specific focus on rates of reinjury, graft failure, associated meniscal pathology, and need for revision surgery.
Methods/Design:
This was a retrospective case series. Using the ICD-10 code for ACL reconstruction, the electronic medical record at our institution was queried for patients who underwent ITB ACL reconstruction between 1/1/2004-12/31/2022. Through chart review, we evaluated patient demographics, average age and mechanism of injury, and additional injuries, and need for revision surgery.
Results:
117 patients, 14% female (16), 86% male (101) were included in the study. The average age at time of ITB ACL reconstruction was 12.0 years. 41 patients, or 35% of patients who underwent an ITB ACL reconstruction had a repeat injury event. Of the reinjured patients, 16 (or 39%) sustained an injury to the ITB graft, with a median time of 43.8 months post operatively. Of the patients with IT band graft injuries, 11 (68.8%) patients required return to OR for revision ACL reconstruction, 1 did not require revision, however, 4 (25%) were lost to follow up. Notably, 7 of the 16 patients who reinjured their ITB graft also sustained an injury to the medial meniscus, and 17 of 41 (41.4%) total reinjured patients sustained isolated medial meniscus tears. The average time from ITB ACLR to medial meniscus injury was 35.5 months. 5 patients had concomitant graft failures and lateral meniscus tears, and 7 of 41 (17%) reinjured patients had isolated lateral meniscus tears.
Conclusions:
While many patients demonstrated durability of the ITB ACL reconstruction, the rate of reinjury, specifically graft failure and medial meniscus tears, and need for revision ACL reconstruction is higher than previously published by other institutions, highlighting a potential deficit in the function of an ITB autograft the need for improved strategies to protect young athletes. While ITB ACL reconstruction has been regarded as a reliable and durable option for most, the rate of repeat injury and need for revision surgery in some should prompt careful consideration of surgical options by surgeons and families.
Comments
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Poster Board Number: 14