I'd like to thank both the AOSSM and my co-authors throughout Saturn, especially the four surgeons who were part of this cohort. So Min has really led us in the Pluto group to look at the prepubescent and the adolescents with growth remaining, those populations of open growth plates. But the older adolescent with closing FICEs, and then the skillfully mature adolescent with closed FICEs, we know this is the most affected age group throughout the ACL population overall, as well as that group at greatest risk for re-tears and complications, so really the highest stakes group. So this study group was formed specifically to look at that cohort. And our first focus was really looking at the IT band technique in the pediatric population and seeing if we might modify it for a skillfully mature adolescent group. Because of the really favorable graft re-rupture rates, as well as strong PROs, some of the best results in the young person's ACL literature. So we are also trying to harness the increased interest in the ALL across sports medicine and sort of modify our technique from pediatric non-anatomic to a really anatomic technique using the IT band. So this technique involves a proximal transection of the IT band, about a 20 to 25 millimeter strip, leaving attached to GERDI's tubercle, and then tubularizing this band-like ligament or tendon, and then making a tunnel through the ALL footprint to the ACL footprint, very similar to the SONTI group, a full tunnel technique, and then feeding the graft from outside in and affixing in a standard tibial tunnel with screws from outside in on the femoral side and tibial side. So we wanted to investigate this technique against the BTB or kind of control group gold standard with a comparative retrospective Level 3 study looking at the perioperative safety complications, postoperative recovery as well as the PROs in a large volume demographically and geographically diverse population in multi-center fashion. So we looked at demographic data, injury data, standard radiographic measurements, the pediatric validated PROs and then secondary outcome measures. So we had 56 in this particular cohort of the IT band compared to 49 BTBs. Those are isolated BTBs and we had similar age, sex and BMI in the two cohorts. Our tibial and femoral tunnel diameters were obviously different, closer to just over 7 with the IT band group and just under 10 with the BTB group. Our operative and tourniquet times were lower in the IT band group. It's a technically straightforward procedure with a low learning curve amongst this group of surgeons who do high volume of pediatric IT band surgeries. The 6-month recovery data and return to sports assessments showed that there was a significantly higher quad strength deficit in the BTB group as we might expect as the IT band allows for a favorable recovery and maintained hip strength. The 9-month recovery metrics showed no significant strength differences between the two cohorts so that BTB group had regained their quad strength. And then similar return to sport, 9 months in the IT band, about 9.5 in the BTB group. In terms of complications, the overall rates were not different between the two groups nor was additional ipsilateral surgeries. But the complications were different between the groups. We did have 7 of our 56 IT bands suffer a re-rupture and then one case in the BTB group for 2% compared to 13%. And then we did have more arthrofibrosis, either cyclops or diffuse arthrofibrosis or both. And then patellar tendonitis and a couple of cases of quad neuropraxia in the BTB group. Our PROs showed slightly favorable results in the IT band group at the 6-month mark with lower or higher PDI-KDC scores as well as statistically significantly higher KUS symptom scores. These differences had evened out by one year. There was a slightly higher activity level in the BTB group probably based on preoperative patient selection bias there amongst the surgeons. And then PROs, all other PROs at the 6- and 1-year mark were even between the two groups. So our preliminary safety and early outcomes data suggests this novel technique may be safe and effective in restoring stability and allowing for return to sport. The early PROs may be favorable or superior, at least comparable to the BTB control group, and then comparable in terms of overall complications. But this 13% early graft rupture rate is obviously concerning. And while there are advantages of this technique with preservation of the flexor and extensor muscle groups, it's a technically simple procedure with small tunnels which allow for a kind of revision-friendly surgery if needed. We're in the phase of continued monitoring and making sure we have methodologically rigorous comparative analysis at the 2- and 5-year marks before we move forward with a previously planned RCT in the IT band versus BTB. Thanks very much. »» Thank you.

AOSSM

co-authors

adolescents

open growth plates

closed growth plates