KSSTA - 2026-05-15 - Journal Article
Biologic gracilis augmentation with iliotibial band enhances recovery and lowers complications in ACL reconstruction compared with hamstring plus lateral tenodesis.
Guen AL, Bohu Y, Etienne AS, Valentin E, Gerometta A, Khiami F, Meyer A, Grimaud O, Cavaignac E, Hardy A
Topics
Key Takeaway
ITBAG achieved comparable return-to-sport rates to HT-LET (65.3% vs. 66.9%) but produced significantly better ACL-RSI scores (87.5 vs. 79.2) and lower overall complication rates, driven primarily by reduced cyclops syndrome in the HT-LET group.
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Summary
This matched retrospective study from the FAST Cohort compared ITBAG versus HT-LET ACL reconstruction in 628 patients, assessing return-to-sport, PROs, and complications at mean 4.2 years. Return-to-sport rates were equivalent (65.3% vs. 66.9%, p=0.73) and time to return was similar (8.4 vs. 8.9 months, p=0.25). ITBAG demonstrated superior Lysholm (96.5 vs. 95) and ACL-RSI (87.5 vs. 79.2) scores, and HT-LET had significantly more complications (p<0.01), predominantly cyclops syndrome.
Key Limitation
Re-rupture rates were low and statistically non-significant (1% vs. 2.9%, p=0.14), meaning the study is underpowered to detect a true difference in the primary stability endpoint.
Original Abstract
PURPOSE
To compare the iliotibial band autograft biologically augmented with gracilis (ITBAG) technique with a hamstring tendon autograft combined with extra-articular lateral tenodesis using fascia lata (HT-LET), in terms of (1) return-to-sport rates, (2) patient-reported functional outcomes and (3) complication rates.
METHODS
This matched retrospective two-group study included patients from the FAST Cohort (French Prospective ACL Study). Patients who underwent revision for graft re-rupture were excluded from the comparative analyses of functional outcomes and return to sport. Return-to-sport status and level, subjective functional scores (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, Anterior Cruciate Ligament-Return to Sport after Injury) and complications requiring reoperation were assessed after a minimum follow-up of 2 years.
RESULTS
A total of 628 patients (314 in each group) were analysed. At a mean follow-up of 4.2 years, 65.3% (203/311) of ITBAG patients and 66.9% (204/305) of HT-LET patients had returned to sport (p = 0.73), with a mean time to return of 8.4 months and 8.9 months, respectively (p = 0.25). The ITBAG group demonstrated significantly better patient-reported outcomes in selected functional scores, including Lysholm (96.5 vs. 95) and ACL-RSI (87.5 vs. 79.2), while other functional measures were similar between groups. Re-rupture rates were low in both groups, occurring in 1% of patients in the ITBAG group and 2.9% in the HT-LET group (p = 0.14). However, the HT-LET group showed a higher incidence of other complications (p < 0.01), mainly due to postoperative cyclops syndrome.
CONCLUSION
Although return-to-sport rates were comparable between techniques, ACL reconstruction using an iliotibial band graft augmented with gracilis resulted in superior functional scores and a lower rate of postoperative stiffness compared with hamstring autograft reconstruction with extra-articular lateral tenodesis.
LEVEL OF EVIDENCE
Level III, cohort study.