Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices

Ahn, Hyeon Wook; Seon, Jong Keun; Song, Eun Kyoo; Park, Chan‐Jin; Lim, Hong An

doi:10.1016/j.arthro.2019.01.051

Cited by 16 publications

(18 citation statements)

References 28 publications

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“…Finally, recent studies comparing fixed versus adjustable buttons have shown no significant differences in their clinical performance, stability, and tunnel widening. 25,26 Considering all these controversies with CBs, being the implant of choice in our practice for many years, we hypothesized that a stronger aperture femoral device would lead to better clinical, radiologic, and stability outcomes in our ACL patients. The AperFix system has different biomechanical properties from an IS providing what is referred to as "expandable fixation," thus avoiding the insertional torque, which can theoretically damage the graft or change its position within the tunnel; it also provides circumferential graft compression rather than the unilateral compression of an IS.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Finally, recent studies comparing fixed versus adjustable buttons have shown no significant differences in their clinical performance, stability, and tunnel widening. 25 , 26 …”

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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“…5,13 –16,36 This technique allows for technical ease and speed 12,18 –20,32 while providing a secure fixation with excellent tensile strength. 1,3,8,9,23,25,32 Clinical data have also demonstrated positive patient-reported outcomes and knee stability with suspensory ACL fixation. 4,27 Alternative graft fixation techniques include the use of interference screw fixation, which has been associated with many drawbacks, including screw divergence, graft laceration, graft advancement within the bone tunnel, and bone plug fractures.…”

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confidence: 97%

Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

O’Brien

Fones

Stoj

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

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“…12 Adjustable cortical fixation devices have shown good clinical results in ankle syndesmosis repair, cruciate ligament reconstruction, and acromioclavicular joint dislocation. 1,2,19 Results of adjustable cortical fixation for quadriceps tendon rupture have not been reported.…”

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confidence: 99%

Adjustable Cortical Fixation Device for Quadriceps Tendon Repair: A Cadaveric Biomechanical Study

Gould

Rate

Abbasi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Adjustable cortical fixation devices have demonstrated utility in orthopaedic applications, such as ankle syndesmosis repair. Purpose: To assess the cyclic gap formation of a quadriceps tendon repair technique using an adjustable cortical fixation device compared with repair with knotless suture anchors and suture tape, a modification of conventional suture anchor repair. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen matched pairs of cadaveric knees were used. Specimens in each pair were randomized to undergo either modified suture anchor repair (control) or adjustable cortical fixation repair. The control repair was performed as previously described. The experimental repair was performed using 2 No. 2 FiberWire sutures placed into the quadriceps tendon in a running locked Krackow configuration and 2 adjustable loop devices passed through transosseous tunnels. The lagging strands of the devices were tensioned to seat the cortical fixation buttons at the inferior patellar pole and then tied to the free Krackow strands at the superior pole to complete the repair. The mean plastic gap (permanent tendon displacement that did not recover with cyclic extension) and mean maximum gap (peak displacement that occurred with cyclic knee flexion and partially recovered with extension) were evaluated during cyclic loading for 500 cycles of full knee extension to 90° of flexion. Results: At all testing intervals, the mean plastic gap was significantly smaller for the cortical fixation group versus the suture anchor group ( P < .02). Similarly, the mean maximum gap was significantly smaller for the cortical fixation specimens at all testing intervals ( P < .01). After cyclic loading, the mean maximum gap was significantly smaller in the cortical fixation group (4.80 ± 1.56 mm) versus the suture anchor group (8.47 ± 1.47 mm; P = < .001). The mean plastic gap was also significantly smaller in the cortical fixation versus the suture anchor group (3.25 ± 1.10 mm vs 6.57 ± 1.62 mm, respectively; P = < .001). Conclusion: Quadriceps tendon repair using an adjustable cortical fixation device demonstrated superior biomechanical properties in cyclic displacement testing compared with repair using the suture anchor technique. Clinical Relevance: These results suggest that an adjustable cortical fixation device is a biomechanically viable alternative for quadriceps tendon repair.

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Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices

Cited by 16 publications

References 28 publications

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

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

Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

Adjustable Cortical Fixation Device for Quadriceps Tendon Repair: A Cadaveric Biomechanical Study

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