Clinical Outcome of Fixed Versus Adjustable Loop Cortical Suspension Devices in Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

Background. Anterior cruciate ligament (ACL) reconstruction has remained the gold standard for ACL injuries, especially for young individuals and athletes exposed to high level sporting activities aiming to return to their preinjury level of activity. Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament reconstruction using hamstring tendons. The aim of this study was to compare the clinical results of using fixed and adjustable loop cortical suspension devices in arthroscopic ACL reconstruction using the Lysholm Knee Scoring Scale after 12 months postoperatively. Material and methods. This study included a total of sixty patients who underwent transportal arthroscopic ACL reconstruction using a hamstring tendon autograft from November 2016 to December 2017. For femoral graft fixation, a fixed-length loop device was used in 30 patients (fixed-loop group) and an adjustable-length loop device was used in 30 patients (adjustable-loop group) randomly.For tibial graft fixation, interference screw was used for all patients. Results. The present study shows that there was no statistically significant difference between the two groups regarding the Lysholm score with highly statistically significant difference between preoperative and postoperative Lysholm score in each group separately. Conclusion. Both fixed loop and adjustable loop devices in ACL reconstruction provided good clinical outcomes but without significant statistical difference between both groups from the clinical point of view postoperatively using the Lysholm score.

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

“…A total of 15 studies were included in this systematic review [ 1 , 3 – 5 , 9 , 11 , 14 , 25 , 28 , 31 , 33 , 34 , 36 , 41 , 43 ]. All studies were screened in full text.…”

“…Three studies [ 4 , 5 , 43 ] included revision surgery in their outcome and two studies [ 28 , 34 ] reported on the number of patients undergoing revision surgery during the study period. Only the study by Asmussen et al [ 4 ] analysed the rate of revision surgery with an OR and found that ALDs had 0.51 (95% CI: 0.24–1.13) lower odds of having a revision surgery compared to FLDs.…”

“…Five studies reported the PROMs with the Lysholm score at the 1-year follow-up [ 25 , 28 , 31 , 33 , 36 ] and seven studies reported them at the 2-years follow-up [ 1 , 2 , 9 , 11 , 14 , 34 , 41 ] (Table 4 ). The meta-analysis for the 2-years Lysholm scores revealed an overall MD in the Lysholm score of 0.17 points (95% CI: -040 – 0.75) higher for the ALD group compared to the FLD group (Fig.…”

“…None of the included studies specified rehabilitation protocols and return-to-sport criteria. Two studies [ 5 , 28 ] reported that patients returned to sports from 6 months postoperatively and the remaining three studies [ 4 , 34 , 43 ] did not report whether the patients returned to sports. The lack of information in the studies on rehabilitation protocols and return-to-sport criteria is of importance since higher sport activity levels and an early return to sports before meeting the appropriate criteria are associated with a greater risk of reinjury and a possible revision surgery [ 15 , 18 ].…”

“…Therefore, the rate of revision surgery is an important outcome when evaluating if ALDs are as safe to use in ACLR as FLDs. New clinical studies that include revision rates have been published in recent years [ 11 , 28 , 31 , 43 ]. These studies may allow for conducting a meta-analysis that has hitherto been difficult due to heterogeneity between studies.…”