Additional tying on the adjustable-loop device improves the outcomes of anterior cruciate ligament reconstruction using hamstring autograft

Abstract

Purpose The purpose of this study was to verify the eicacy of a novel technique for additional tying on the adjustable-loop device to prevent stress concentration on the graft loop end and gradual loop lengthening. Methods A total of 124 patients who underwent anterior cruciate ligament reconstruction using hamstring autografts from 2014 to 2017 were included in this retrospective study. After 1:1 propensity score matching, two groups were formed (group I: 50 patients without tying vs. group II: 50 patients with tying). Anterior laxity was evaluated using side-to-side diferences. Tunnel length, loop length, and graft-tunnel gap were measured using follow-up magnetic resonance imaging. The signal-to-noise ratio was calculated at the loop end, loop inner side, tunnel entrance, and graft mid-substance. The clinical outcomes were assessed using the International Knee Documentation Committee score, Lysholm score, pivot shift test, and Lachman test. ResultsThe average follow-up period was 63.2 ± 4.8 and 53.8 ± 11.9 months in groups I and II, respectively. Anterior laxity showed that side-to-side diferences improved signiicantly 6 months postoperatively in both the groups. Although the anterior laxity improved in group II (2.9 ± 1.0 to 1.6 ± 0.8, p < 0.001), it deteriorated in group I (2.5 ± 1.5 to 3.3 ± 1.3 mm, p < 0.001) at the inal follow-up. The graft-tunnel gap was signiicantly larger in group I (p < 0.001). The signal-to-noise ratios of the loop end and loop inner side were signiicantly higher in group I (p < 0.001 and p = 0.020, respectively). The clinical outcomes at the inal follow-up were not signiicantly diferent between the groups. Conclusion The additional tying on the adjustable-loop device was not superior to the control group in clinical stability examination or outcome. However, it was efective in anterior laxity measured by stress radiographs, preventing stress on the adjustable-loop device, and gradual graft loop lengthening. Level of evidence Level III.

Biomechanical Stability of Third-Generation Adjustable Suture Loop Devices Versus Continuous Loop Button Device for Cortical Fixation of ACL Tendon Grafts

“…Retensioning of the ALB, as well as tying a knot over the button, after reaching the desired loop length has been shown to significantly reduce elongation. 8 , 9 , 33 Considering the results of the present study and current literature, additional measures such as tying a knot over the button do not appear to be necessary when using the implants tested in the present study.…”

Biomechanical Comparison of 3 Adjustable-Loop Suspensory Devices for All-Inside ACL Reconstruction: A Time-Zero Full-Construct Model

“…Clinical results with ALD have shown generally good postoperative knee stability and failure rate without significance to FLD with tibial screw fixation. 11 This is a time-zero, in vitro biomechanical study focusing on the stabilization potential of available ALD for femoral fixation in all-inside ACLR. Further short- and long-term translational animal and clinical follow-up studies are required to assess adequate fixation strength of variable ALD for graft stabilization throughout graft healing and maturation.…”

Clinical outcomes of anterior cruciate ligament reconstruction using loop cruciate ligament fixation system

“…Loop accommodates various lengths of graft. Single size titanium button is available with multiple pre-measure loop sizes of 7,8,10,12,15,20,25,30,35, and 40mm lengths. It promotes insertion site healing and rests on the cortical bone surface.…”

“…The suture loop is then tied down, providing stable fixation of the graft within the bone tunnels. 12 The experimental result shows that loop loosening caused by cyclic loads may be a problem when using adjustablelength cortical fixation devices, but not when using fixedloop cortical fixation devices. 13 In theory, adjustablelength cortical fixation devices allow the bone-tendon junction to be adjusted at the femoral tunnel aperture under arthroscopic direct vision, which conventional fixed-loop devices could not do consistently.…”