Similar outcomes between gracilis‐reinforced iliotibial band graft and hamstring with modified Lemaire technique in combined anterior cruciate ligament reconstruction with lateral tenodesis: A propensity score‐matched analysis

Abstract Purpose While both iliotibial band graft augmented by gracilis tendon (ITB + G) and hamstring autograft with modified Lemaire lateral extra‐articular tenodesis (STG + LET) are established techniques for addressing rotatory instability in anterior cruciate ligament reconstruction, no direct comparison exists between these approaches. The purpose of this study was to provide the first direct comparison between these two surgical techniques regarding graft survival, functional outcomes and return to sport. Methods This single‐centre, single‐surgeon retrospective study analyzed 56 patients (28 per group) after 1:1 propensity score matching based on age, gender and Tegner activity scale. Primary end point was failure (graft retear or secondary meniscal lesion). Secondary outcomes included the International Knee Documentation Committee (IKDC), anterior cruciate ligament‐return to sport after surgery (ACL‐RSI) scores, and return to sport rate. Kaplan–Meier survival analysis and between‐group comparisons were performed using appropriate statistical tests. Results At mean follow‐up of 53.3 ± 6.4 months, failure‐free survival rates at 24 months were 85.7% (95% confidence interval [CI]: 66.3–94.4) for STG + LET and 89.3% (95% CI: 70.4–96.4) for ITB + G ( p = 0.664). Graft retear rate was 7.1% (STG + LET: 3.6%, ITB + G: 10.7%). Secondary meniscal injuries occurred equally (14.3%) in both groups. Return‐to‐sport rate was 89.3% at mean of 9.6 ± 3.9 months. Mean IKDC scores were 87.5 ± 11.4 for STG + LET and 83.6 ± 16.3 for ITB + G, with 73.7% achieving Patient Acceptable Symptom State criteria. ACL‐RSI scores were similar between groups (STG + LET: 74.2 ± 24.3 and ITB + G: 73.5 ± 26.8). Conclusion No significant differences were found between ITB + G and STG + LET techniques regarding failure rates, return to sport and functional outcomes. Both techniques achieved satisfactory results in this cohort, with similar complication profiles. This comparison provides valuable clinical guidance, supporting surgical decision‐making based on surgeon experience. Level of Evidence Level III, retrospective cohort study.