Biomechanical Evaluation of an Adjustable Loop Suspensory Anterior Cruciate Ligament Reconstruction Fixation Device: The Value of Retensioning and Knot Tying

Noonan, Benjamin C.; Dines, Joshua S.; Allen, Answorth A.; Altchek, David W.; Bedi, Asheesh

doi:10.1016/j.arthro.2016.02.010

Cited by 64 publications

(96 citation statements)

References 21 publications

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“…30 Tibial anterior translation >3.0 mm is indicative for ACL rupture with high sensitivity 16,17 and is, therefore, often used as a threshold to determine clinical failure in isolated device testing. 2,20,27,30 In this regard, when put under constant tension, all tested CFDs performed successfully clinically, although initial elongation of FLD was considerably greater than that of the adjustable-length devices. We attributed this difference to suture slippage and plastic deformation of the knot during initial tensioning, which could be circumvented by applying a higher preload.…”

Section: Discussionmentioning

confidence: 86%

“…Previous literature has shown that CFDs withstand greater forces than those needed during surgery and subsequent rehabilitation. 2,15,18,20,21,24,27,29 However, several studies have found differences in the elongation behavior of CFDs, favoring fixed-over adjustable-length devices. 2,18,20,27,30 Whereas confident estimations on repetitive ACL forces during rehabilitation activities are lacking, 27 a review of the relevant literature revealed the force interval between 50 and 250 N is the most common used for cyclic testing.…”

Section: Discussionmentioning

confidence: 99%

“…2,15,18,20,21,24,27,29 However, several studies have found differences in the elongation behavior of CFDs, favoring fixed-over adjustable-length devices. 2,18,20,27,30 Whereas confident estimations on repetitive ACL forces during rehabilitation activities are lacking, 27 a review of the relevant literature revealed the force interval between 50 and 250 N is the most common used for cyclic testing. 2,18,21,24,[29][30][31]37 To date, it is unclear what amount of fixation lengthening constitutes clinical failure.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

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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.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

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“…20 Although adjustable-loop devices allowed for more displacement than fixed-loop devices, these authors postulated that this could be overcome clinically by retensioning the graft following initial fixation. 20 These results were subsequently confirmed and expanded by Noonan et al and Smith et al 21,22 Specifically, Noonan et al showed a 62% tension loss of initial tension for interference screw fixation of soft-tissue grafts, representing 0.53 mm time-zero laxity, which could be recaptured by the adjustable-loop fixation device (TightRope, Arthrex, Naples, Florida). 21 In another soft-tissue ACL fixation testing study, retensioned adjustable-loop TightRope devices were associated with lower initial elongation and equivalent total elongation when compared with fixed-loop constructs.…”

mentioning

confidence: 75%

Independent Suture Tape Internal Brace Reinforcement of Bone–Patellar Tendon–Bone Allografts: Biomechanical Assessment in a Full-ACL Reconstruction Laboratory Model

et al. 2019

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Internal bracing for anterior cruciate ligament (ACL) surgery is a relatively new concept. The purpose of this study was to evaluate the effects of an “independent” button-fixed internal brace on the biomechanical properties of ACL reconstruction in a full-construct experimental model. Three groups (n = 10 each) were tested in a full-construct porcine-bone model with human bone–patellar tendon–bone allografts using different reconstruction techniques: interference screw fixation on femur and tibia (S-S group), adjustable-loop device (ALD) fixation on the femur with tibial interference screw without suture tape (ALD-S group), and with internal brace (ALD-S-IB group). Measured outcomes included cyclic displacement, stiffness, and ultimate load to failure. The ALD-S-IB group (2.9 ± 0.8 mm) displaced significantly less than the ALD-S (4.2 ± 0.9 mm; p = 0.015) and S-S group (4.3 ± 1.1 mm; p = 0.017). No significant difference was found between the ALD-S and the S-S group. Construct stiffness was significantly higher for the ALD-S-IB group (156 ± 23 N/mm) and the ALD-S group (122 ± 28 N/mm) than for the S-S group (104 ± 40 N/mm; p = 0.003 and p = 0.0042), but there was no significant difference between both ALD groups. Similarly, ultimate loads in the ALD-S-IB (758 ± 128 N) and the ALD-S groups (628 ± 223 N) were significantly greater than in the S-S group (416 ± 167 N; p < 0.001 and p = 0.025), but there was no significant difference between ALD groups. Adding an internal brace reinforcement to an ALD in a full-construct experimental model significantly decreased cyclic displacement by 31% without increasing construct stiffness or ultimate load significantly. These results indicate that suture tape internal bracing of bone–patellar tendon–bone allograft ACL reconstruction decreases cyclic displacement during experimental testing, which has clinical implications regarding initial construct stability.

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“…All patients were observed for a minimum of 2 years. They found that femoral fixation by use of the fixed-loop device or femoral fixation by use of the adjustable-loop device showed similar clinical outcomes but did not reduce tunnel widening after hamstring ACL reconstructions [13] . Author found additional advantages of adjustable length device that final tightening of the graft could be done after tibial fixation of the graft which reassured the adequate tensioning of graft.…”

Section: Discussionmentioning

confidence: 99%

Comparative study on fixed versus adjustable-length loop device for femoral fixation of graft in anterior cruciate ligament reconstruction

Pokharel¹,

Bhalodia²,

A³

et al. 2018

Int. J. Orthop. Sci.

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Aims and Objectives: Cortical suspension devices have been widely used in ACL reconstruction for femoral side graft fixation. Fixed-length and adjustable-length loop devices are two common suspensory loop devices that are used in ACL reconstruction. They both have their own biomechanical pros and cons. The purpose of this study is to determine the difference in functional outcome of anatomical single bundle ACL reconstruction using fixed length versus adjustable length loop in femoral fixation of quadrupled hamstring graft. Material and methods: It is a longitudinal prospective study conducted in Bone and Joint Centre, Kokilaben Dhirbhai Ambani Hospital (KDAH), Mumbai from Jan 2014 to June 2016. There were 60 patients enrolled in the study. The first 30 patients were treated with Arthroscopic ACL reconstruction in the first 30 patients were done with quadrupled hamstring graft from ipsilateral limb fixed with Endobutton on femoral side and bio-absorbable intrafix tibial screw, similarly in subsequent 30 patients ACL reconstruction were done with quadrupled hamstring graft from ipsilateral limb fixed with Tightrope on femoral side and bio-absorbable intrafix tibial screw. Their clinical and functional status were assessed pre-operatively on the day prior to surgery and the last follow up at one following the surgery with Tegner-Lysholm Score and 2000 IKDC scores. Results: The average Tegner-Lysolm score before surgery in Endobutton group was 56.63±6.7 and post op score at last follow up was 93.97±4.1 and for Tightrope group it was 56.5±7.1 and 94.7±3.7 respectively. The average 2000 IKDC score before surgery in Endobutton group was 46.16±6.1and postop score at last follow up was 82.52±4.2 and for Tightrope group it was 46.57±6.5 and 83.98±4.1 respectively. Two sample student t-test was conducted to compare the mean of post-operative Tegner-Lysolm score and 2000 IKDC for each group it showed P value for Tegner-Lysolm score to be 0.75 and that for 2000 IKDC score to be 0.7, which not statistically significant to reject the null hypothesis. Discussion and conclusion: Cortical suspension devices for femoral tunnel graft fixation are very efficient devices whether Fixed-length or adjustable length. Fixed-length and adjustable loop cortical suspension devices are equally effective in femoral fixation of graft in ACL reconstruction.

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Biomechanical Evaluation of an Adjustable Loop Suspensory Anterior Cruciate Ligament Reconstruction Fixation Device: The Value of Retensioning and Knot Tying

Cited by 64 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

Independent Suture Tape Internal Brace Reinforcement of Bone–Patellar Tendon–Bone Allografts: Biomechanical Assessment in a Full-ACL Reconstruction Laboratory Model

Comparative study on fixed versus adjustable-length loop device for femoral fixation of graft in anterior cruciate ligament reconstruction

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