A radiological evaluation of loop length change in adjustable versus fixed loop femoral cortical fixation devices in arthroscopic anterior cruciate ligament reconstruction: a prospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20233269Keywords:
Fixed, Adjustable, Loop-lengthening, Button, Radiological, ACLAbstract
Background: In anterior cruciate ligament reconstructions, fixed devices require over-drilling to flip the button whereas loops of adjustable devices can be adjusted intraoperatively, and they minimize over-drilling. But they can loosen rendering the reconstruction incompetent. Most studies comparing them are bio-mechanical studies. Our aim was to record and compare loop length change radiologically in adjustable versus fixed devices in clinical settings.
Methods: 32 patients were divided into 2 groups of 16 patients each. Hamstring graft were prepared. It was loaded in the suspension device and the apex of the graft was marked using silicon vascular radio-opaque marker. In adjustable devices, lengthening was checked after cycling and re-tensioning was done intra-operatively. Post-surgery, digital X-ray of the knee was taken in true antero-posterior and lateral view. Distance between the centre point of the button and the centre-point of the radio-opaque inert silicon marker was recorded at immediate post-operative and at 6 weeks respectively and compared.
Results: 15 patients in each group were incorporated. Intra-operatively, loop lengthening was seen in all 15 patients with adjustable loop and re-tensioning was done. 2 of the 15 cases showed evidence of radiological loop lengthening however in both cases the lengthening was less than 3 mm and thus was not significant.
Conclusions: We in in vivo radiology based clinical study did not find any significant loop lengthening in patients with adjustable loop devices. Hence fixed and adjustable loop devices are comparable.
References
Ranjan R, Gaba S, Goel L, Asif N, Kalra M, Kumar R, et al. In vivo comparison of a fixed loop (EndoButton CL) with an adjustable loop (TightRope RT) device for femoral fixation of the graft in ACL reconstruction: A prospective randomized study and a literature review. J Orthop Surg Hong Kong. 2018;26(3):2309499018799787.
Pasquali M, Plante MJ, Monchik KO, Spenciner DB. A comparison of three adjustable cortical button ACL fixation devices. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2017;25(5):1613-6.
Johnson JS, Smith SD, LaPrade CM, Turnbull TL, LaPrade RF, Wijdicks CA. A biomechanical comparison of femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction under high loads. Am J Sports Med. 2015;43(1):154-60.
Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC. Femoral suspension devices for anterior cruciate ligament reconstruction: do adjustable loops lengthen? Am J Sports Med. 2014;42(2):343-9.
Eguchi A, Ochi M, Adachi N, Deie M, Nakamae A, Usman MA. Mechanical properties of suspensory fixation devices for anterior cruciate ligament reconstruction: comparison of the fixed-length loop device versus the adjustable-length loop device. The Knee. 2014;21(3):743-8.
Boyle MJ, Vovos TJ, Walker CG, Stabile KJ, Roth JM, Garrett WE. Does adjustable-loop femoral cortical suspension loosen after anterior cruciate ligament reconstruction? A retrospective comparative study. The Knee. 2015;22(4):304-8.
Chang MJ, Bae TS, Moon Y-W, Ahn JH, Wang JH. A Comparative Biomechanical Study of Femoral Cortical Suspension Devices for Soft-Tissue Anterior Cruciate Ligament Reconstruction: Adjustable-Length Loop Versus Fixed-Length Loop. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2018;34(2):566-72.
Petre BM, Smith SD, Jansson KS, de Meijer P-P, Hackett TR, LaPrade RF, et al. Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study. Am J Sports Med. 2013;41(2):416-22.
Uribe-Echevarria B, Magnuson JA, Amendola A, Bollier MJ, Wolf BR, Hettrich CM. Anterior Cruciate Ligament Reconstruction: A Comparative Clinical Study Between Adjustable and Fixed Length Suspension Devices. Iowa Orthop J. 2020;40(1):121-7.
Jin C, Paluvadi SV, Lee S, Yoo S, Song E-K, Seon J-K. Biomechanical comparisons of current suspensory fixation devices for anterior cruciate ligament reconstruction. Int Orthop. 2018;42(6):1291-6.
Singh S, Shaunak S, Shaw SCK, Anderson JL, Mandalia V. Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Indian J Orthop. 2020;54(4):426-43.
Ahn JH, Ko TS, Lee YS, Jeong HJ, Park JK. Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation. Clin Orthop Surg. 2018;10(2):157-66.
Choi N-H, Yang B-S, Victoroff BN. Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices. Am J Sports Med. 2017;45(4):826-31.
Ahmad SS, Hirschmann MT, Voumard B, Kohl S, Zysset P, Mukabeta T, et al. Adjustable loop ACL suspension devices demonstrate less reliability in terms of reproducibility and irreversible displacement. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2018;26(5):1392-8.
Lanzetti RM, Monaco E, De Carli A, Grasso A, Ciompi A, Sigillo R, et al. Can an adjustable-loop length suspensory fixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study. The Knee. 2016;23(5):837-41.