Physeal Sparing Combined Extra-articular/Intra-articular Iliotibial Band ACL Reconstruction in Children: A Long-term Strength, Dynamic Balance, and Functional Analysis

Background: Despite excellent midterm clinical outcomes in several studies of pediatric anterior cruciate ligament (ACL) treatment, the modified McIntosh ACL reconstruction (ACLR) with iliotibial band (ITB) autograft (ITB ACLR) has been referred to as “nonanatomic” in nature. Moreover, the technique remains underinvestigated in terms of postoperative lower extremity recovery, strength, balance metrics, and hop tests, with little evidence on the effect of time from surgery. Purpose: To assess performance parameters between ITB ACLR and contralateral noninjured knees of patients who underwent the procedure at various time points before testing. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ITB ACLR between 1 and 20 years before study initiation were identified from the surgical database of 3 high-volume ACL surgeons at a tertiary care pediatric hospital. Each patient in the cohort, which was randomly selected to achieve a broad distribution of times from surgery, participated in isometric strength tests (quadriceps, hamstring, and hip abductor), dynamic Y-balance tests, and functional hop tests. The limb symmetry index (LSI) was utilized for comparisons between knees, with equivalence and correlation analyses performed. Patient-reported outcomes (Pediatric International Knee Documentation Committee [Pedi-IKDC] form) and activity level (Hospital for Special Surgery Pediatric Functional Activity Brief Scale [HSS Pedi-FABS]) were recorded on the day of testing. Results: A total of 40 patients (9 in 1 to