Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review

Singh, Sarvpreet; Shaunak, Shalin; Shaw, Sebastian C K; Anderson, John L.; Mandalia, Vipul

doi:10.1007/s43465-019-00022-4

Cited by 12 publications

(16 citation statements)

References 49 publications

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“…Compared to the FLD, adjustable-loop femoral cortical suspension devices are relatively new. They offer various advantages: graft maximization in femoral tunnels, avoidance of the over drilling of the femoral tunnel, and obviation of the need to calculate the loop length [1,5,6]. Our study supports the ndings from previous studies and provides more information for clinicians.…”

Section: Discussionsupporting

confidence: 82%

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Computed Tomography Imaging Results of Single Band Anterior Cruciate Ligament Reconstruction: A Retrospective Study Comparing Fixed- and Adjustable-Length Loop Cortical Fixation on the First Day After Surgery

Yin

Zhang

Liu³

et al. 2021

Preprint

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Background: Cortical suspensory femoral fixation is commonly performed for graft fixation of the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. This study aimed to compare the morphology of femoral tunnel and graft insertion between fixed-length loop devices (FLD) and adjustable-length loop devices (ALD) using computed tomography (CT) images on the first day after hamstring ACL reconstruction. Methods: Overall, 94 patients who underwent ACL reconstruction from January 2016 to January 2021 were included. For femoral graft fixation, FLD (Smith & Nephew, ENDOBUTTON) and ALD (DePuy Synthes, Mitek sports medicine, RIGIDLOOP Adjustable cortical system) were used in 56 and 38 patients, respectively (FLD and ALD groups). For evaluation of the morphology of the humeral tunnel and graft depth, CT scans were performed immediately on the first postoperative day. The gap distance between the top of the graft and the socket tunnel end, the length of lateral bone preservation, and the depth of graft insertion were measured on the CT images. Results: The gap distance and bone preservation significantly differed between the two groups (1.90±1.81 mm and 14.35±4.67 mm in ALD groups; 7.08±2.63 mm and 7.35±3.62 mm in FLD groups, respectively; both P values < 0.01). The graft insertion depth did not significantly differ between the groups. Conclusion: The ALD group had a smaller gap distance, better bone preservation, and a similar graft insertion length in the femoral tunnel when compared to the FLD group. Based on these findings, ALD might be better for bone preservation and tunnel utilization in patients with short femoral tunnels. Trial registration: retrospectively registered

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Section: Discussionsupporting

confidence: 82%

“…Several graft xation techniques have been applied for graft xation in the femoral side, all of which have demonstrated positive clinical outcomes. However, there is still no consensus regarding the best xation technique to use in the femoral side [5,6].…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Imaging Results of Single Band Anterior Cruciate Ligament Reconstruction: A Retrospective Study Comparing Fixed- and Adjustable-Length Loop Cortical Fixation on the First Day After Surgery

Yin

Zhang

Liu³

et al. 2021

Preprint

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show abstract

Section: Discussionmentioning

confidence: 98%

“…The most commonly used methods are cortical buttons (CB) or adjustable buttons, followed by cross-pins (CP) and interference screws (IS), providing cortical, corticocancellous, and compressive cancellous anchoring in respect. In the most recent systematic reviews and network meta-analyses of randomized control studies, [22][23][24] there was no differences in failure rate, knee stability, functional outcomes, or revision rates, although Yan et al 23 reported that IS was more likely to perform better results in comparison with CB and CP. Colvin et al, 11 in a similar meta-analysis in 2011, showed similar postoperative functional outcomes of aperture fixation (IS) in comparison with other methods (away from the joint line), but there was a trend toward decreased risk of surgical failures (relative risk ¼ 0.57) for the IS.…”

Section: Discussionmentioning

confidence: 99%

No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients

Panagopoulos

Mylonas

Kouzelis

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare anterior cruciate ligament (ACL) autograft reconstruction using fixed-looped suspensory versus expandable femoral fixation through the anteromedial portal. Methods: After we performed prospective power analysis and obtained institutional review board, 70 patients with ACL rupture were block randomized to the expandable or suspensory femoral fixation group (35 in each group). All patients received autologous hamstring autograft through the anteromedial portal and fixed with a sheath-screw system in the tibia. The primary outcome measures were anteroposterior knee stability at 2 years' follow-up measured using the KT-1000 arthrometer and the degree of femoral and tibial tunnels' widening measured by the use of computed tomography imaging performed immediately postoperative and 12 months postsurgery. Secondary outcome measures included pain score on a visual analog scale, the subjective International Knee Documentation Committee 2000 assessment form, the Lysholm score, and the Tegner activity scale at 3, 6, 12, and 24 months. Results: Twenty-four patients were excluded from further analysis, leaving a total of 48 patients (24 in each group) for the final evaluation. The anteroposterior knee stability (KT-1000) showed no difference between groups at 24 months' follow-up (P ¼ .31). The percentile widening (%) of femoral and tibial tunnel at 1-year follow-up showed no difference also, except for greater values at the tibial coronal point T2 (P ¼ .065) and tibial sagittal point T1 (P ¼ .033) in the group of cortical buttons. Secondary clinical outcomes showed no statistical differences between groups at 3, 6, 12, and 24 months' postoperatively. Numerical pain scale (visual analog scale) was similar in both groups except for postoperative day 7, where the AperFix group showed better results (P ¼ .014). There were no major intraoperative and late postoperative complications in any of the groups. Conclusions: Our results showed no significant differences in knee anteroposterior stability, tunnel enlargement or other clinical outcomes comparing expandable versus cortical button fixation in anteromedial hamstrings ACL reconstruction. Level of Evidence: Level II, randomized controlled trial.

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“…Several recent biomechanical studies have shown considerable loosening of the adjustable-loop system under conditions of cyclic-loading stress compared to a fixed-loop device, which could affect clinical and radiological outcomes following ACLR [1,2,[5][6][7]. The available body of literature indicates that there is still a scarcity of adequate data to conclude the possible loosening of adjustable-loop devices and their clinical outcomes [8]. The present study uses an adjustable-loop system to analyze the loosening of the ACLR and clinical results in terms of various scores and instability measurements.…”

Section: Introductionmentioning

confidence: 99%

Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years

Khan

Asif

Aziz

et al. 2022

JCM

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Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices.

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Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review

Cited by 12 publications

References 49 publications

Computed Tomography Imaging Results of Single Band Anterior Cruciate Ligament Reconstruction: A Retrospective Study Comparing Fixed- and Adjustable-Length Loop Cortical Fixation on the First Day After Surgery

Computed Tomography Imaging Results of Single Band Anterior Cruciate Ligament Reconstruction: A Retrospective Study Comparing Fixed- and Adjustable-Length Loop Cortical Fixation on the First Day After Surgery

No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients

Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years

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