Operative Treatment of Pediatric ACL Tear, Iliotibial Band Reconstruction

Abstract

Pediatric anterior cruciate ligament (ACL) tears are rising due to increased youth sport participation, often prompting early surgical interventions. Over-the-top ACL reconstruction with iliotibial band (ITB) autograft, aimed at minimizing growth disturbances, is a preferred technique for prepubescent patients (Tanner Stage I or II). Surgical technique involves harvest of the ITB with passage in the over-the-top position into the knee, extra-articular tenodesis at the femoral condyle, and tibial fixation distal to the physis and medial to the tubercle. Outcomes include excellent function, high return-to-sport rates, and low graft rupture rates, comparable to alternatives. Systematic reviews support ITB reconstruction, showing high return-to-activity rates and low growth disturbance incidences. Biomechanical studies affirm satisfactory kinematic restoration postsurgery and superior rotatory control. ITB reconstruction offers a promising technique for pediatric ACL tears, warranting further research on long-term efficacy and refined patient selection.