Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial
Restricted accessResearch articleFirst published online April, 2020
Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial
The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain.
Purpose:
To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift.
Study Design:
Randomized controlled trial; Level of evidence, 2.
Methods:
Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures (P < .05).
Results:
A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B.
Conclusion:
The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores.
Registration:
ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)
AmisAABullAMLieDT. Biomechanics of rotational instability and anatomic anterior cruciate ligament reconstruction. Oper Tech Orthop. 2005;15(1):29-35.
2.
AndersonAFIrrgangJJKockerMSMannBJHarrastJJ. The International Knee Documentation Committee subjective knee evaluation form: normative data. Am J Sports Med. 2006;34:128-135.
3.
ArdernCLTaylorNFFellerJAWebsterKE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functional and contextual factors. Br J Sports Med. 2014;48(21):1543-1552.
4.
AyeniORChahalMTranMNSpragueS. Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):767-777.
5.
BeynnonBDHallJSSturnickDR, et al. Increased slope of the lateral tibial plateau subchondral bone is associated with greater risk of non-contact ACL injury in females but not in males: a prospective cohort study with a nested matched case-control analysis. Am J Sports Med. 2014;42(5):1039-1048.
6.
BriggsKKLysholmJTegnerYRodkeyWGKockerMSSteadmanJR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009;37(5):890-897.
7.
BriggsKKSteadmanJRHayCJHinesSL. Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med. 2009;37(5):898-901.
8.
ChristensenJJKrynchAJEngasserWMVanheesMKCollinsMSDahmDL. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43(10):2510-2514.
9.
ClaesSBartholomeeusenSBellemansJ. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg. 2014;80(1):45-49.
10.
DevittBMBellSWArdernCL, et al. The role of extra-articular tenodesis in primary anterior cruciate ligament reconstruction: a systematic review with meta-analysis and best evidence synthesis. Orthop J Sports Med. 2017;5(10):2325967117731767.
11.
DevittBMBouguennecNBarfodKWPorterTWebsterKEFellerJA. Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of osteoarthritis: a systematic review and best evidence synthesis. Knee Surg Sports Traumatol Arthrosc. 2017;25(4):1149-1160.
12.
FerrettiAConteducaFMonacoEDe CarliAD’ArrigoC. Revision anterior cruciate ligament reconstruction with doubled semitendinosis and gracilis tendons and lateral extra-articular reconstruction. J Bone Joint Surg Am. 2006;88(11):2373-2379.
13.
FerrettiAMonacoDPonzoA, et al. Combined intra-articular and extra-articular reconstruction in anterior cruciate ligament deficient knee: 25 years later. Arthroscopy. 2016;32(10):2039-2047.
14.
FreedmanKBD’AmatoMJNedeffDDKazABachBR. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31(1):2-11.
15.
GalwayHRMacIntoshDL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980;147:45-50.
GetgoodABryantDFirthA, et al. The stability study: a protocol for a multicenter randomized clinical trial comparing anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis in individuals who are at high risk of graft failure. BMC Musculoskelet Disord. 2019;20:216.
18.
GoldblattJPFitzsimmonsSERichmondJC. Reconstruction of the anterior cruciate ligament: meta-analysis of the patellar tendon versus hamstring graft. Arthroscopy. 2005;21(7):791-803.
19.
GuentherDRahnemai-AzarAABellKM, et al. The anterolateral capsule of the knee behaves like a sheet of fibrous tissue. Am J Sports Med. 2017;45(4):849-855.
20.
HartiganDECarrollKWKosarekFJPiaseckiDPFleishcliJFD’AllessandroDF. Visibility of anterolateral ligament tears in anterior cruciate ligament-deficient knees with standard 1.5-Tesla magnetic resonance imaging. Arthroscopy. 2016;32(10):2061-2065.
21.
HelitoCPHelitoPVPCostaHPDemangeMKBordalo-RodriguesM. Assessment of the anterolateral ligament of the knee by magnetic resonance imaging in acute injuries of the anterior cruciate ligament. Arthroscopy. 2017;33(1):140-146.
22.
HoshinoYAraujoPAhldenM, et al. Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc. 2012;20:732-736.
23.
HuserLENoyesFRJurgensmeierDLevyMS. Anterolateral ligament and iliotibial band control of rotational instability in the anterior cruciate ligament-intact knee: defined by tibiofemoral compartment translations and rotations. Arthroscopy. 2017;33(3):595-604.
24.
KittlCEl-DaouHAthwalKK, et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med. 2016;44(2):345-354.
25.
KocherMSSteadmanJRBriggsKKSterettWIHawkinsRJ. Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32(3):629-634.
26.
KosyJDMandaliaVI. Revisiting the anterolateral ligament of the knee. J Knee Surg. 2016;29(7):571-579.
27.
LandreauPCatteeuwAHamieFSaithnaASonnery-CottetBSmigielskiR. Anatomic study and reanalysis of the nomenclature of the anterolateral complex of the knee focusing on the distal iliotibial band: identification and description of the condylar strap. Orthop J Sports Med. 2019;7(1):2325967118818064.
28.
LeeDWKimJGChoSIKimDH. Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction. Am J Sports Med. 2019;47(2):324-333.
29.
LevinsJGSturnickDRArgentieriEC, et al. Geometric risk factors associated with noncontact anterior cruciate ligament graft rupture. Am J Sports Med. 2016;44(10):2537-2545.
30.
LoseeRE. Diagnosis of chronic injury to the anterior cruciate ligament. Orthop Clin North Am. 1985;16:83-97.
31.
MagnussenRAReinkeEKHustonLJ; Moon Knee Group. Effect of high-grade preoperative knee laxity on 6-year anterior cruciate ligament reconstruction outcomes. Am J Sports Med. 2018;46(12):2865-2872.
32.
MakhniECPadakiASPetridisPD, et al. High variability in outcome reporting patterns in high-impact ACL literature. J Bone Joint Surg Am. 2015;97(18):1529-1542.
33.
MarcacciMZaffagniniSGiordanoGIaconoFLo PrestiM. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med. 2009;37(4):707-714.
34.
MARS Group; CooperDEDunnWRHustonLJ, et al. Physiologic preoperative knee hyperextension is a predictor of failure in an anterior cruciate ligament revision cohort. Am J Sports Med. 2018;46(12):2836-2841.
35.
MatsumotoH. Mechanism of the pivot shift. J Bone Joint Surg Br. 1990;72(5):816-821.
36.
MetaFLizzioVAJildehTRMakhniEC. Which patient reported outcomes to collect after anterior cruciate ligament reconstruction. Ann Joint. 2017;2(21):1-14.
37.
MonacoEFerrettiALabiancaL, et al. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):870-877.
38.
MonacoEHelitoCPRedlerA, et al. Correlation between magnetic resonance imaging and surgical exploration of the anterolateral structures of the acute anterior cruciate ligament-injured knee. Am J Sports Med. 2019;47(5):1186-1193.
39.
MonacoELabiancaLConteducaFDe CarliAFerrettiA. Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc. 2007;15:1168-1174.
40.
MusahlVHoshinoYAhldenM, et al. The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):724-731.
41.
NakamuraKKogaHSekiyaI, et al. Evaluation of the pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2377-2383.
42.
NoyesFRHuserLEJurgensmeierDWalshJLevyMS. Is an anterolateral ligament reconstruction required in the ACL-reconstructed knee with associated injury to the anterolateral structures?Am J Sports Med. 2017;45(5):1018-1027.
43.
NoyesFRHuserLELevyMS. The effect of an ACL reconstruction on controlling rotational knee stability in knees with intact and physiologic laxity of secondary restraints as defined by tibiofemoral compartment translations and graft forces. J Bone Joint Surg Am. 2018;100(7):586-597.
44.
O’BrienSJWarrenRFWickiewiczTL, et al. The iliotibial band lateral sling procedure and its effect on the results of anterior cruciate ligament reconstruction. Am J Sports Med. 1991;19(1):21-24.
45.
ParsonsEMGeeAOSpiekermanCCavanaghPR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med. 2015;43(3):669-674.
46.
PomajzlRMaerzTShamsCGuettlerJBicosJ. A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy. 2015;31(3):583-591.
47.
PorterMDShadboltB. “Anatomic” single-bundle anterior cruciate ligament reconstruction reduces both anterior translation and internal rotation during the pivot shift. Am J Sports Med. 2014;42(12):2948-2954.
48.
PorterMDShadboltB. Femoral aperture fixation improves anterior cruciate ligament graft function when added to cortical suspensory fixation: an in vivo computer navigation study. Orthop J Sports Med. 2016;4(9):2325967116665795.
49.
PorterMDShadboltBPomroyS. The augmentation of revision anterior cruciate ligament reconstruction with modified iliotibial band tenodesis to correct the pivot shift: a computer navigation study. Am J Sports Med. 2018;46(4):839-845.
50.
RezendeFCde MoraesVYMartimbiancoALLuzoMVDa SilveiraFBellotiJC. Does combined intra- and extraarticular ACL reconstruction improve function and stability? A meta-analysis. Clin Orthop Relat Res. 2015;473(8):2609-2618.
51.
RoesslerPPSchuttlerKFHeyseTJWirtzDCEfeT. The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: a review of anatomy and surgical concepts. Arch Orthop Trauma Surg. 2016;136(3):305-313.
52.
RoosEMRoosHPLohmanderLSEkdahiCBeynnonBD. Knee injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88-96.
53.
SchonJMMoastsheGBradyAW, et al. Anatomic anterolateral ligament reconstruction of the knee leads to over-constraint at any fixation angle. Am J Sports Med. 2016;44(10):2546-2556.
54.
SongGYHongLZhangHZhangJLiYFengH. Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthroscopy. 2016;32(5):898-905.
55.
Sonnery-CottetBLutzCDaggettM, et al. The involvement of the anterolateral ligament in rotational control of the knee. Am J Sports Med. 2016;44(5):1209-1214.
56.
Sonnery-CottetBSaithnaACavalierM, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI study group. Am J Sports Med. 2017;45(7):1547-1557.
57.
Sonnery-CottetBThaunutMFreychetBPupimBHMurphyCGClaesS. Outcome of combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med. 2015;43(7):1598-1605.
58.
SundemoDSemertNKartusJ, et al. Increased postoperative manual knee laxity at 2 years results in inferior long-term subjective outcome after anterior cruciate ligament reconstruction. Am J Sports Med. 2018;46(11):2632-2645.
59.
TashmanSCollonDAndersonKKolowichPAnderstW. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32(4):975-983.
60.
TegnerYLysholmJ. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43-49.
61.
TheinRBoorman-PadgettJStoneKWickiewiczTLInhauserCWPearleAD. Biomechanical assessment of the anterolateral ligament of the knee. J Bone Joint Surg Am. 2016;98(11):937-943.
62.
TrichineFAlsaatiMChouteauJMoyenBBouzitounaMMazaR. Patellar tendon autograft reconstruction of the anterior cruciate ligament with and without lateral plasty in advanced-stage chronic laxity: a clinical, prospective, randomized, single-blind study using passive dynamic X-rays. Knee. 2014;21(1):58-65.
63.
Van der WattLKhanMRothrauffBB, et al. The structure and function of the anterolateral ligament of the knee: a systematic review. Arthroscopy. 2015;31(3):569-582.e3.
64.
WebbJMSalmonLJLeclercEPinczewskiLARoeJP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013;41(12):2800-2804.
65.
YamamotoYTsudaEMaedaS, et al. Greater laxity in the anterior cruciate ligament-injured knee carries a higher risk of postreconstruction pivot shift. Am J Sports Med. 2018;46(12):2859-2864.
