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

Abstract

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.

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

“… 5 Furthermore, retrospective studies have found noninferiority of ALB graft fixation in comparison with CLB. 13 , 27 , 39 A systematic review and meta-analysis concluded that the scarce evidence suggests no difference in knee stability and subjective knee function between ALB and CLB. 14 …”

“…5 Furthermore, retrospective studies have found noninferiority of ALB graft fixation in comparison with CLB. 13,27,39 A systematic review and meta-analysis concluded that the scarce evidence suggests no difference in knee stability and subjective knee function between ALB and CLB. 14 In previous generations of ALB, different approaches were presented to prevent slippage of the constructs and to improve primary stability.…”

No Difference in Bone Tunnel Enlargement and Clinical Outcome between Cortical Suspension and Hybrid Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction

“…Their loop can be tightened and adjusted according to the tunnel length during the surgical process, thereby decreasing the possibility of a bungee cord effect 14 . Although the adjustable mechanism is superior in design, some studies have pointed out that the loop will loosen and lengthen during cyclic loads, creating graft laxity 15 . Furthermore, biomechanical studies have shown a considerable amount of loosening in adjustable‐loop devices, which might affect clinical results after ACLR 16,17 .…”

“… 14 Although the adjustable mechanism is superior in design, some studies have pointed out that the loop will loosen and lengthen during cyclic loads, creating graft laxity. 15 Furthermore, biomechanical studies have shown a considerable amount of loosening in adjustable‐loop devices, which might affect clinical results after ACLR. 16 , 17 The application of a bioabsorbable interference screw allows the graft to be strongly fixed at the level of the joint line, which will help minimize BTE.…”

Functional Outcomes Following Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction Using the Sironix Titanium Button and the Polyetheretherketone (PEEK) Button: A Retrospective Observational Study

“…In recent years, adjustable-loop devices are the newer version of femoral cortical suspension devices, as they are simple to use, provide excellent results, and offer multiple advantages. One of the most commonly used devices is the titanium adjustable loop button that was used for soft-tissue fixation to the bone since titanium is thought to be the most biocompatible metal, due to its bio-inertness, corrosion resistance, high fatigue limit, and capacity for osseointegration [ 11 , 12 , 13 ]. Polyetheretherketone (PEEK) materials are stable and biocompatible and are utilized in orthopedic surgery [ 14 ].…”