Comparison of Lower Extremity Recovery After Anterior Cruciate Ligament Reconstruction With Transphyseal Hamstring Versus Extraphyseal Iliotibial Band Techniques in Skeletally Immature Athletes

Abstract

Background:The influence of graft type on recovery after anterior cruciate ligament reconstruction (ACLR) has not been adequately studied in pediatric patients.Purpose:To describe lower extremity functional recovery parameters at the 6-month mark after ACLR across 3 distinct groups of skeletally immature patients: pediatric male patients with transphyseal hamstring grafts (PM-HS), pediatric female patients with transphyseal hamstring grafts (PF-HS), and pediatric male patients with extraphyseal iliotibial band grafts (PM-ITB).Study Design:Cohort study; Level of evidence, 3.Methods:Thigh circumference, knee range of motion, lower extremity strength, dynamic balance, and hop test performance were assessed in all patients 6 months postoperatively. All participants were ≤15 years of age with open physes. The limb symmetry index was used to compare deficits between the operated and uninvolved limbs for all 3 groups (PM-HS, PF-HS, and PM-ITB). Analysis of variance with post hoc correction was employed.Results:A total of 93 pediatric patients who underwent ACLR (PM-HS: n = 21 [mean age, 13.6 ± 1.0 years]; PF-HS: n = 33 [mean age, 13.4 ± 0.7 years]; PM-ITB: n = 39 [mean age, 12.5 ± 1.3 years]) were examined. There was no statistically significant difference in thigh circumference, range of motion, dynamic balance, or hop test performance between the groups. Of the various additional comparisons analyzed, there were statistical differences in hamstring strength deficits among the 3 groups (P = .004). The PM-HS group showed a greater hamstring strength deficit (–32.2% relative to healthy limb) than the PM-ITB group (–5.4% relative to healthy limb) (P = .012). The hamstring strength deficit of the PF-HS group (–18.7% relative to healthy limb) was less than that of the PM-HS group and greater than that of the PM-ITB group but not statistically significant in either case.Conclusion:Significant hamstring strength deficits were detected in the PM-HS group compared with the PM-ITB group at 6 months following ACLR. Such findings may influence decisions regarding graft selection, timing of return to sports, and postoperative rehabilitation regimens.

Migrating Myofibroblastic Iliotibial Band-Derived Fibroblasts Represent a Promising Cell Source for Ligament Reconstruction

“…This necessitates the surgical reconstruction of the ACL mainly performed by hamstring or patellar tendon autografts [28]. In some cases, ITB tissue is used as an ACL graft [29].…”

Outcome Measures After ACL Injury in Pediatric Patients: A Scoping Review

“…＃References 1, 4, 6, 7, 11 –21, 23 –27, 29 –34, 39, 40, 42 –52, 54, 56 –59, 61, 63, 66, 67, 72, 74 –78, 80, 81, 83 –85, 87, 89, 91 –93, 98, 99, 101, 102.…”

Effect of Subcutaneous Tissue on Changes in Thigh Circumference Following Anterior Cruciate Ligament Reconstruction

“…1). These levels were used for thigh circumference measurements in previous studies [11,12,[14][15][16].…”

“…Therefore, clarifying the relationship between thigh circumference and muscles and subcutaneous fat CSAs following ACL reconstruction is of particular importance. Some studies have examined the relationship between thigh circumference and muscle function after a relatively long period of time following ACL reconstruction (i. e., 6 months and 1 and 3 years) [5,6,13,14]. However, to our knowledge, no study has examined the relationship between thigh circumference and subcutaneous fat CSA, or CSAs of muscles around knee joints which are obtained by MR imaging system, relatively shortly after ACL reconstruction.…”

“…Moreover, discrepancies in thigh circumference between the uninjured and injured legs of patients with prior ACL injury have been shown to be greatest at 4 weeks following reconstruction [15,16]. Measuring thigh circumference at 4 weeks after ACL reconstruction, which is shorter compared to previous studies [5,6,13,14], would therefore be more important in terms of evaluating the degree of muscle atrophy in the patients' thighs.…”