Related Experiment Video
Updated: May 17, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Biologic gracilis augmentation with iliotibial band enhances recovery and lowers complications in ACL reconstruction
Alexandre Le Guen1, Yoann Bohu2, Adrien S Etienne2
1Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France.
Purpose:
To compare the iliotibial band autograft biologically augmented with gracilis (ITBAG) technique with a hamstring tendon autograft combined with extra-articular lateral tenodesis using fascia lata (HT-LET), in terms of (1) return-to-sport rates, (2) patient-reported functional outcomes and (3) complication rates.
Methods:
This matched retrospective two-group study included patients from the FAST Cohort (French Prospective ACL Study). Patients who underwent revision for graft re-rupture were excluded from the comparative analyses of functional outcomes and return to sport. Return-to-sport status and level, subjective functional scores (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, Anterior Cruciate Ligament-Return to Sport after Injury) and complications requiring reoperation were assessed after a minimum follow-up of 2 years.
Results:
A total of 628 patients (314 in each group) were analysed. At a mean follow-up of 4.2 years, 65.3% (203/311) of ITBAG patients and 66.9% (204/305) of HT-LET patients had returned to sport (p = 0.73), with a mean time to return of 8.4 months and 8.9 months, respectively (p = 0.25). The ITBAG group demonstrated significantly better patient-reported outcomes in selected functional scores, including Lysholm (96.5 vs. 95) and ACL-RSI (87.5 vs. 79.2), while other functional measures were similar between groups. Re-rupture rates were low in both groups, occurring in 1% of patients in the ITBAG group and 2.9% in the HT-LET group (p = 0.14). However, the HT-LET group showed a higher incidence of other complications (p < 0.01), mainly due to postoperative cyclops syndrome.
Conclusion:
Although return-to-sport rates were comparable between techniques, ACL reconstruction using an iliotibial band graft augmented with gracilis resulted in superior functional scores and a lower rate of postoperative stiffness compared with hamstring autograft reconstruction with extra-articular lateral tenodesis.
Level Of Evidence:
Level III, cohort study.