title: Effects of reinforcement with the iliotibial tract flap in ACL reconstruction using bone-patellar tendon-bone.
abstract: BACKGROUND
  We attempted to reinforce the transplanted ligament by wrapping it with the iliotibial tract (ITT) flap to get more volume and to protect the graft from impingement in the intercondylar space postoperatively in reconstruction of the anterior cruciate ligament (ACL) using bone-patellar tendon-bone (BTB), and investigated the results in comparison with those of BTB alone.
  
  
  METHODS
  The study included 88 cases (88 knees). Group A comprised 43 knees with the reinforcement and group B 45 knees with BTB alone. Both groups were evaluated by second-look arthroscopy, magnetic resonance imaging (MRI), manual testing, International Knee Documentation Committee (IKDC) score, and histopathological evaluation more than 2 years after the reconstruction.
  
  
  RESULTS
  In the second-look arthroscopic findings, 84% of the reconstructed ACL in group A had good appearance, and no fibrous split was observed. The ratio of fibrous disorder was significantly less in group A in comparison with group B (p=0.0037). Distinct reduction of the tension of the reconstructed ligament was observed in 9% of group A and 36% of group B (p=0.0088). Regarding the results of the Lachman test, the ratio of the negative group was higher in group A (p=0.0067). In the MRI findings fulfilled pictures to the inside of the reconstructed ligament were observed in 77% of the patients photographed in group A. In contrast, the fibrous split was observed in 55% in group B.
  
  
  CONCLUSIONS
  Reinforcement by wrapping with the ITT flap for the BTB autograft was effective in ACL reconstruction. The ratio of fibrous disorder and reduction of tension in the reconstructed ligament decreased.
authors.affiliation: Department of Orthopaedic Surgery, Saiseikai Nara Hospital, 4-643 Hachijyou Nara-shi, 630-8145 Nara, Japan. m-i@ah7.mopera.ne.jp
authors.forename: Makato
authors.initials: M
authors.lastname: Iwai
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Koujirou
authors.initials: K
authors.lastname: Okahashi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takakura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Samma
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujisawa
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D005260:Female; D005355:Fibrosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018919:Neovascularization, Physiologic / Q000502:physiology; D010329:Patella; D012038:Regeneration / Q000502:physiology; D009418:S100 Proteins / Q000032:analysis; D024162:Second-Look Surgery; D013524:Surgical Flaps; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome
chemical_list: D009418:S100 Proteins