Revision ACL Reconstruction With a Lateral Extra-Articular Procedure Using a Hybrid Iliotibial Band Graft Shows Outcomes Comparable to BTB with Modified Lemaire Tenodesis

Abstract

To compare clinical outcomes after a minimum of 2 years of follow-up in patients undergoing revision anterior cruciate ligament reconstruction (R-ACLR) combined with a lateral extra-articular procedure using a hybrid iliotibial band graft augmented with allograft (ITB-AG) versus bone–patellar tendon–bone autograft with modified Lemaire tenodesis (BPTB-LET). A retrospective analysis was performed on patients who underwent R-ACLR between 2018 and 2023 at two centers, each using a single surgical technique. Inclusion criteria were revision within 24 months of primary graft failure and a minimum follow-up of 2 years. Patients with multiligament injury, concomitant osteotomy, or refusal to participate were excluded. The primary outcome was graft failure. Secondary outcomes included IKDC subjective score, Lysholm score, complications, side-to-side anterior laxity, and pivot-shift grade. A total of 195 patients were included (BPTB-LET, n=105; ITB-AG, n=90), with comparable baseline characteristics. Mean follow-up was longer in the BPTB-LET group (38±9 vs 34±7 months; P=0.0005). Meniscal tears and repairs were more frequent in the ITB-AG group, which also had a smaller graft diameter (8.8±0.7 vs 9.3±0.5 mm; P=0.0001). Failure rates were similar between groups (5.7% vs 4.4%; P=0.7551). IKDC (90.7±10.8 vs 88.3±10.1; P=0.0026) and Lysholm (94.6±10.8 vs 90.8±9.0; P<0.00001) scores were statistically higher in the ITB-AG group but not clinically meaningful. Postoperative laxity and complication rates were comparable. At mid-term follow-up, the modified ITB-AG technique demonstrated graft survival and clinical outcomes comparable to BPTB-LET, without increased complications, supporting its use in revision ACL reconstruction.