Fixed- Versus Adjustable-Loop Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review

Onggo, James Randolph; Nambiar, Mithun; Pai, Vishal

doi:10.1016/j.arthro.2019.02.029

Cited by 26 publications

(28 citation statements)

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“…A systemic review revealed that 11 of 13 biomechanical studies reported significantly larger maximum irreversible displacement in ALDs than fixedloop devices. 10 The ALD also exhibited greater displacement at the preloading condition and most displacement during the first cycle when compared with the fixed-loop device. 2,11 Retensioning is proposed by several researchers 8,9,11 to prevent significant displacement during cyclic loading.…”

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confidence: 87%

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction

Choi

Yang

Kang

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Biomechanical studies have demonstrated significant loosening of the adjustable-loop device as compared with the fixed-loop device used in anterior cruciate ligament reconstruction. Retensioning of the adjustable loop has been recommended; however, the timing of the retensioning is unknown. Hypothesis: Early (ER) and late retensioning (LR) will show similar gapping between the femoral tunnel and graft on follow-up magnetic resonance imaging (MRI) and similar clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 101 patients who underwent hamstring anterior cruciate ligament reconstruction using the adjustable-loop device for femoral fixation between June 2016 and January 2018. All patients a had follow-up MRI on postoperative day 1. Patients with revision surgery and those with reinjury after reconstruction were excluded. In the ER group, retensioning and knot tying of the initially tightened adjustable loop were performed after the flip of the button and before the graft was fixed at the tibia. In the LR group, retensioning and knot tying were performed after initial tightening of the adjustable loop and graft fixation at the tibial side. The tunnel-graft gap measured on multiplanar reformatted images of MRI scans was compared between the groups, as were clinical outcomes. Results: The mean age of the patients at the time of surgery was 30.3 years (range, 14-61 years). ER and knot tying were performed in 56 patients and LR and knot tying in 45. Preoperative characteristics of the 2 groups showed no significant differences. The mean ± SD tunnel-graft gap was 1.5 ± 2.0 mm in the ER group and 5.4 ± 4.0 mm in the LR group ( P < .001). There were no significant differences in clinical outcomes between the groups. Conclusion: ER and knot tying demonstrated less tunnel-graft gap than that of LR. However, there were no differences in clinical outcomes according to the timing of retensioning.

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confidence: 87%

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction

Choi

Yang

Kang

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Onggo et al 18. systematically compared the biomechanical and clinical outcomes between adjustable-loop devices and fixed-loop devices in the femoral fixation of ACLR using either a hamstring autograft or allograft.…”

Section: Discussionmentioning

confidence: 99%

Comparison of fixed versus adjustable-loop device for femoral graft fixation in anterior cruciate ligament reconstruction: a retrospective cohort study

Bagherifard

Rahimi

Ghaderi

et al. 2022

Current Orthopaedic Practice

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Background: Fixed-loop and adjustable-loop are two types of cortical suspension devices that are used for graft fixation in anterior cruciate ligament reconstruction (ACLR). In this study, the authors compared clinical and functional outcomes of these devices in ACLR surgery. Methods: In a retrospective study, 60 patients who underwent ACLR using either fixed-loop (30 patients) or adjustable-loop were included. Clinical measures were Lachman test, pivot shift test, KT-1000, lack of extension, and flexion. Functional measures were 12-item Short-Form Health Survey, including the Physical Component Summary and the Mental Component Summary, International Knee Documentation Committee score, and Lysholm-Tegner activity scale. Results: The mean age of the patients was 31±7.5 yr. The mean follow-up of the patients was 18.5±6.4 mo. The grading of the Lachman test, pivot shift test, and KT-1000 were not significantly different between the study groups (P=0.47, P=1, and P=0.6, respectively). Lack of extension and flexion were not significantly different between the study groups (P=0.79 and P=0.28, respectively). The Physical Component Summary, Mental Component Summary, International Knee Documentation Committee, and Lysholm-Tegner activity scale were statistically comparable between the two study groups (P=0.46, P=0.68, P=0.55, P=0.77, respectively). Graft failure (KT>5 mm) was seen in seven patients (23.3%) of the fixed-loop group and four patients (13.3%) of the adjustable-loop group (P=0.31). Conclusions: Clinical and functional outcomes of fixed and adjustable-loop devices are comparable when used for femoral fixation in patients undergoing ACLR. Level of Evidence: Level IV.

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“…(3,4) The rst generation of suspensory devices consisted of a xed-loop (FL) attaching the graft to a metallic button. Even though FL xation provides excellent stability with high xation strength (5,6), it has drawbacks too. Fixed-loop devices require accurate measurement during tunnel preparation because of their predetermined loop length.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, complete lling of the femoral bone tunnel is possible, reducing the attic height. (5,7,8) However, adjustable-loop devices may lengthen under cyclic loading as reported in biomechanical studies (9)(10)(11)(12)(13)(14), causing laxity of the graft. This issue may be reduced with re-tensioning and knot tying of the AL construct.…”

Section: Introductionmentioning

confidence: 99%

“…This issue may be reduced with re-tensioning and knot tying of the AL construct. (5,9,11) The all-inside (AI) ACL reconstruction technique has been demonstrated to result in less post-operative pain and is bone conserving (15,16), but relies on AL suspensory xation on the femoral and tibial side. Good biomechanical and clinical results are reported for AI ACL reconstruction in various studies.…”

Section: Introductionmentioning

confidence: 99%

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ACL reconstruction with femoral and tibial adjustable- versus fixed-loop suspensory fixation: A retrospective cohort study.

Schützenberger

Keller

Grabner

et al. 2022

Preprint

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Background: Cortical suspensory fixation (CSF) devices gain more and more popularity as a reliable alternative to interference screws for graft fixation in anterior cruciate ligament (ACL) reconstruction. Adjustable-loop fixation may be associated with increased anterior laxity and inferior clinical outcome. The purpose of the study was to compare anterior laxity and clinical outcome after minimally invasive all-inside ACL reconstruction using an adjustable-loop (AL) to a standard technique with a fixed-loop (FL) CSF device.Methods: Patients who underwent primary single-bundle ACL reconstruction with a quadrupled hamstring autograft at a single institution between 2012 and 2016 were reviewed. In the AL group minimally invasive popliteal tendon harvesting was performed with an all-inside approach (femoral and tibial sockets). In the FL group a traditional anteromedial approach was used for tendon harvesting and a femoral socket and full tibial tunnel were drilled. An objective clinical assessment was performed with Telos x-rays and the International Knee Documentation Committee (IKDC) Objective Score. Patient-reported outcomes (PRO) included the IKDC Subjective Score, the Lysholm Knee Score, the Knee Injury and Osteoarthritis Score (KOOS) and the Tegner Activity Scale.Results: A total of 67 patients were enrolled in this retrospective study with a mean follow-up of 4 (± 1.5) years. The groups were homogenous at baseline regarding age, gender, and the time to surgery. At follow-up, no statistically significant differences were found regarding anterior laxity (AL: 2.3 ± 3 mm vs. FL: 2.3 ± 2.6 mm, p=0.981). PRO scores were comparable between the AL and FL groups (IKDC score, 84.8 vs 88.8, p=0.185; Lysholm 87.3 vs 89.9, p=0.380; KOOS 90.7 vs 91.4, p=0.720; Tegner 5.5 vs 6.2, p=0.085). The rate of saphenous nerve lesions was significantly lower in the AL group with popliteal harvesting of the tendon (8.3% vs 35.5%, p=0.014).Conclusion: The use of an adjustable-loop device on the femoral and tibial side led to similar stability and clinical results compared to a fixed-loop device.

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Fixed- Versus Adjustable-Loop Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review

Cited by 26 publications

References 50 publications

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction

Comparison of fixed versus adjustable-loop device for femoral graft fixation in anterior cruciate ligament reconstruction: a retrospective cohort study

ACL reconstruction with femoral and tibial adjustable- versus fixed-loop suspensory fixation: A retrospective cohort study.

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