Biomechanical Comparison of Fixed-Loop and Adjustable-Loop Cortical Suspensory Devices for Metaphyseal Femoral-Sided Soft Tissue Graft Fixation in Anatomic Anterior Cruciate Ligament Reconstruction Using a Porcine Model

Nye, Darin D.; Mitchell, W. Ryan; Liu, Wei; Ostrander, Roger V.

doi:10.1016/j.arthro.2016.12.014

Cited by 37 publications

(52 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…FTDs have been extensively tested in vivo 4,5,22,26,33 and ex vivo in isolated device setups, 1,11,20,27,30 as well as in porcine knee ACL reconstructions. 11,24,25,27,28,30,37,38 Petre et al 30 implemented an isolated device testing protocol with the same preload and cyclic loading limits and similar travel velocity. After a total of 1000 cycles, FTD elongated 1.10 ± 0.20 mm on average, which is in approximate agreement with the mean 1000-cycle displacement 1.00 ± 0.31 mm in the current investigation.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Götschi

Rosenberg

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Implant fixation by means of a cortical fixation device (CFD) has become a routine procedure in anterior cruciate ligament reconstruction. There is no clear consensus whether adjustable-length CFDs are more susceptible to loop lengthening when compared with pretied fixed-length CFDs.Purpose: To assess biomechanical performance measures of 3 types of CFDs when subjected to various loading protocols.Study Design: Controlled laboratory study.Methods: Three types of CFDs underwent biomechanical testing: 1 fixed length and 2 adjustable length. One of the adjustablelength devices is based on the so-called finger trap mechanism, and the other is based on a modified sling lock mechanism. A device-only test of 5000 cycles (n ¼ 8 per group) and a tendon-device test of 1000 cycles (n ¼ 8 per group) with lower and upper force limits of 50 and 250 N, respectively, were applied, followed by ramp-to-failure testing. Adjustable-length devices then underwent further cyclic testing with complete loop unloading (n ¼ 5 per group) at each cycle, as well as fatigue testing (n ¼ 3 per group) over a total of 1 million cycles. Derived mechanical parameters were compared among the devices for statistical significance using Kruskal-Wallis analysis of variance followed by post hoc Mann-Whitney U testing with Bonferroni correction.Results: All CFDs showed elongation <2 mm after 5000 cycles when tested in an isolated manner and withstood ultimate tensile forces in excess of estimated peak in vivo forces. In both device-only and tendon-device tests, differences in cyclic performance were found among the devices, favoring adjustable-length fixation devices over the fixed-length device. Completely unloading the suspension loops, however, led to excessive loop lengthening of the finger trap device, whereas the modified sling lock device remained stable throughout the test. The fixed-length device displayed superior ultimate strength over both adjustable-length devices. Both adjustable-length devices showed adequate fatigue behavior during high-cyclic testing.Conclusion: All tested devices successfully prevented critical construct elongation when tested with constant tension and withstood ultimate loads in excess of estimated in vivo forces during the rehabilitation phase. The finger trap device gradually lengthened excessively when completely unloaded during cyclic testing.Clinical Relevance: Critical loop lengthening may occur if adjustable-length devices based on the finger trap mechanism are repeatedly unloaded in situ.

show abstract

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Götschi

Rosenberg

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…[4][5][6] These techniques are typically minimally invasive (even "all-inside" 4 ) and have been shown to have excellent fixation strength. [7][8][9] One study has shown statistically significant displacement of adjustable-length suspensory devices biomechanically, 10 whereas others have shown their cyclical and ultimate failure strength to be similar to interference screws or fixed length devices. [7][8][9] A major positive of adjustable loop devices is they allow the surgeon to retension the graft after cycling the knee, a benefit that cannot be overstated and one that is unable to be accomplished with either interference screw or fixed device applications.…”

Section: See Related Article On Page 3063mentioning

confidence: 99%

“…[7][8][9] One study has shown statistically significant displacement of adjustable-length suspensory devices biomechanically, 10 whereas others have shown their cyclical and ultimate failure strength to be similar to interference screws or fixed length devices. [7][8][9] A major positive of adjustable loop devices is they allow the surgeon to retension the graft after cycling the knee, a benefit that cannot be overstated and one that is unable to be accomplished with either interference screw or fixed device applications. This current study adds to the growing body of literature that confirms the minimal loop length changes of the adjustable device while also showing excellent clinical outcomes.…”

Section: See Related Article On Page 3063mentioning

confidence: 99%

Editorial Commentary: The Search for the Perfect Fixation Method in Anterior Cruciate Ligament Reconstruction Continues

Nuelle¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Anterior cruciate ligament reconstruction fixation methods have long been the subject of frequent debate. The ability to optimize tendon-to-bone or bone-to-bone healing with secure graft fixation in a manner that can be performed as minimally invasively as possible is the goal. As we continue to develop and understand various graft fixation methods, our ability to achieve this goal continues to improve.

show abstract

“…A s the authors of the study "Biomechanical Comparison of Fixed-Loop and Adjustable-Loop Cortical Suspensory Devices for Metaphyseal Femoral-Sided Soft Tissue Graft Fixation in Anatomic Anterior Cruciate Ligament Reconstruction Using a Porcine Model," Nye, Mitchell, Liu, and Ostrander provide a useful contribution to the literature. 1 The purpose of this study was to assess whether variations of somewhat similar cortical suspensory fixation devices would reveal similar biomechanical properties under time zero laboratory testing conditions.…”

Section: See Related Article On Page 1225mentioning

confidence: 99%

Editorial Commentary: Not All Cortical Suspensory Fixation Devices Are Created Equal

DeBerardino¹

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Biomechanical Comparison of Fixed-Loop and Adjustable-Loop Cortical Suspensory Devices for Metaphyseal Femoral-Sided Soft Tissue Graft Fixation in Anatomic Anterior Cruciate Ligament Reconstruction Using a Porcine Model

Cited by 37 publications

References 21 publications

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Editorial Commentary: The Search for the Perfect Fixation Method in Anterior Cruciate Ligament Reconstruction Continues

Editorial Commentary: Not All Cortical Suspensory Fixation Devices Are Created Equal

Contact Info

Product

Resources

About