Low graft re-rupture rate after primary ACL reconstruction using a modified MacIntosh iliotibial band technique with gracilis augmentation: Minimum 6-year follow-up.

PURPOSE: Combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction has gained renewed interest to improve rotational stability and reduce graft failure. This study evaluated graft re-rupture rates, functional and return-to-sport (RTS) outcomes at a minimum 6-year follow-up after primary reconstruction using a modified MacIntosh iliotibial band (ITB) technique with gracilis augmentation. METHODS: This retrospective single-centre cohort study included patients from the FAST Cohort (French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study) who underwent primary reconstruction using this technique between January 2015 and October 2019. The primary outcome was graft re-rupture. Patient-reported outcome measures, RTS outcomes and complications were assessed at final follow-up. Multivariable logistic regression identified factors associated with graft re-rupture and RTS at the pre-injury level. RESULTS: A total of 265 patients were included in graft re-rupture and complication analyses, with a mean follow-up of 84.3 ± 10.7 months. Graft re-rupture occurred in 13 patients (4.9%). Complications other than graft failure occurred in 5 patients (1.9%). Additional surgical procedures excluding ACL revision were required in 13 patients (4.9%), most commonly meniscectomy for secondary meniscal lesions (4.2%). Functional outcomes were analysed in 252 patients after excluding graft re-ruptures and improved significantly compared with preoperative values (p < 0.001), with median subjective International Knee Documentation Committee and Lysholm scores of 92.0 and 95.0, respectively. Among 249 patients who practised sport before injury, 228 (91.6%) returned to sport, including 154 (61.8%) who returned to the same sport, of whom 69 (44.8%) returned to their pre-injury level. Median time to RTS was 8.0 months. Younger age and medial meniscal tear were independently associated with graft re-rupture. CONCLUSION: Primary ACL reconstruction using a modified MacIntosh ITB technique with gracilis augmentation resulted in a low graft re-rupture rate, favourable patient-reported outcome scores and a high overall RTS rate at a minimum 6-year follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.