Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis

Abstract

Purpose Button implants with either a fixed-loop device (FLD) or adjustable-loop device (ALD) are used frequently in Anterior Cruciate Ligament Reconstruction (ACLR). Since revision ACLR is associated with poorer clinical outcomes, it is important to investigate the difference in risk of revision between FLDs and ALDs. Therefore, this paper aims to systematically assess the risk of revision ACLR between ALDs and FLDs as well as secondary outcomes such as knee stability and patient reported outcomes (PROMs). Methods The online databases Embase, Medline (PubMed), and SPORTDiscus were searched, comparing FLDs and ALDs for femoral fixation in patients undergoing primary ACLR with hamstring autografts. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Due to heterogeneity a meta-analysis on revision rates were not possible. A random-effect meta-analysis was performed for the secondary outcomes and the quality of evidence was evaluated using the GRADE approach. Results Fifteen cohort studies with a total of 2686 patients were included. None of the studies found a clinical difference between ALDs and FLDs in either revision rates, knee stability or PROMS. However, the quality of evidence was graded “very low” due to study designs, risk of bias, and heterogeneity. Conclusion Studies of better quality are needed to investigate the risk of revision ACLR between ALDs and FLDs. There was no difference in knee stability and PROMs between the ALDs and FLDs; however, the interpretation of these results is challenging due to low quality of evidence. 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

“… 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 …”

“…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. 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.…”

Kết Quả Phục Hồi Chức Năng Khớp Gối Trên Bệnh Nhân Phẫu Thuật Nội Soi Tái Tạo Đồng Thời Hai Dây Chằng Chéo Bằng Mảnh Ghép Tự Thân

“…Tuy nhiên khả năng tự điều chỉnh của vòng treo góp phần rút ngắn thời gian cho cuộc mổ [8]. Một nghiên cứu phân tích tổng hợp trên 2686 bệnh nhân qua 15 báo cáo cho thấy chưa tìm thấy sự khác biệt có ý nghĩa thống kê giữa kết quả sau phẫu thuật tái tạo dây chằng có sử dụng vòng treo có điều chỉnh và vòng treo cố định ở ba nội dung là mức độ lỏng gối, tỷ lệ mổ lại và bảng tính toán kết quả lâm sàng được báo cáo của bệnh nhân (Patient reported outcome measures -PROMs) [7] [1]. Năm 2022, Trần Hoàng Tùng báo cáo nghiên cứu trên 32 BN thời gian theo dõi 5 năm với kích thước mảnh ghép DCCT và DCCS lần lượt là 9,29±0,77mm và 8,55±0,82mm đạt kết quả điểm Lysholm trung bình 89,7±6,7 điểm [5].…”

Correction: Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis

“…This erratum adds an abstract to the article Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis [ 1 ]. The abstract was missing from the article version published 21 Oct 2022.…”