The Modified Ellison Technique: A Distally Fixed Iliotibial Band Transfer for Lateral Extra-articular Augmentation of the Knee

Lateral Extra-articular Tenodesis with Iliotibial Band Using Knotless All-Suture Anchor Femoral Fixation

Common injuries, such as anterior cruciate ligament (ACL) tears, can result in both anterior and rotational instability of the knee. An arthroscopic anterior cruciate ligament reconstruction (ACLR) method has been shown to be effective in restoring anterior translational stability, but this could be followed by persistent rotational instability by means of residual pivot shifts or repeat instability episodes. Alternative techniques, such as a lateral extraarticular tenodesis (LET), has been proposed as a technique for preventing persistent rotational instability following ACLR. This article presents a case of a LET using an autologous central slip of iliotibial (IT) band with fixation to the femur using a 1.8-mm knotless all-suture anchor.

Effect of Radiological Evidence of Kaplan Fiber Injury on the Clinical and Functional Outcomes After Acute Anterior Cruciate Ligament Reconstruction

BACKGROUND

A paucity of information is available regarding the clinical outcomes of patients with radiological evidence of Kaplan fiber (KF) injury who undergo anterior cruciate ligament (ACL) reconstruction (ACLR).

PURPOSE/HYPOTHESIS

The purpose was to compare clinical and functional outcomes in patients undergoing acute primary ACLR with and without magnetic resonance imaging (MRI) evidence of KF injury. The hypothesis was that there would be no difference in clinical or functional outcomes in patients with versus those without radiological evidence of KF injury.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

MRI analysis was conducted on patients in a longitudinal prospective study of ACL injury. Only patients who had an MRI scan and had undergone isolated primary ACLR within 60 days of injury were included. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. A total of 32 patients with KF injury (mean age, 24.2 years; 21 male, 11 female) were identified and matched for sex, age, graft type, and preinjury activity with 90 patients who had intact KF. Patients were followed up at 12 months with KT-1000 arthrometer measurements of side-to-side difference in anterior knee laxity, single- and triple-hop limb symmetry index (LSI), Marx activity and International Knee Documentation Committee (IKDC) scores, and return to sport (RTS) rates at 12 months and 24 months.

RESULTS

No differences were found in anterior knee laxity and single- and triple-hop LSI values between the KF-intact and KF-injured cohorts at 12 months. No differences in Marx and IKDC scores were found between the groups at 12 months and 2 years. The overall rate of RTS within 24 months was 75% (92/122), and 5 patients (2 KF-injured; 3 KF-intact) had a subsequent graft rupture.

CONCLUSION

We found no difference in clinical or functional outcomes in patients with and without radiological evidence of KF injury who underwent acute primary ACLR. Based on these findings, the radiological presence of KF injury at the time of acute ACL injury should not be regarded as a risk factor for a negative prognosis after ACLR.

Physeal-Sparing Anterior Cruciate Ligament Reconstruction with Iliotibial Band Autograft in the Skeletally Immature Knee

Conventional adult anterior cruciate ligament reconstruction techniques are controversial in skeletally immature patients due to the risk of iatrogenic physeal damage and potential growth disturbance. The physeal-sparing, combined intra- and extra-articular anterior cruciate ligament reconstruction using an autogenous iliotibial band was developed to mitigate this risk in prepubescent, skeletally immature patients, with excellent functional outcomes and a low revision rate. This article describes the surgical details of this reproducible reconstruction technique.