Abstract
PurposeSuspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II).Materials and methodsThis was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery.ResultsPostoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9).ConclusionACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results.Level of evidence1.
Highlights
Arthroscopic anatomic reconstruction is the preferred surgical option for anterior cruciate ligament (ACL) tears [1]
Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test)
The exclusion criteria consisted of patients with severe osteoarthritic changes (Kellgren and Lawrence grades 3 and 4) [14] in the knee joint, any prior intra/extraarticular ligament surgery, patients with intra- or extraarticular ligament injury other than an ACL injury, and ACL injury associated with intraarticular fracture
Summary
Arthroscopic anatomic reconstruction is the preferred surgical option for anterior cruciate ligament (ACL) tears [1]. Additional drilling of the femoral tunnel is required so that the button comes out of the lateral femoral cortex This leaves some part of the socket devoid of graft where graft motion can take place. Anatomical tunnel creation can sometimes result in short tunnel length and inadequate graft length inside the bone [4]. To address these shortcomings, second generation adjustable suspensory loop fixation devices were innovated TightRope (TR) (Arthrex Inc., Naples, FL, USA). Second generation adjustable suspensory loop fixation devices were innovated TightRope (TR) (Arthrex Inc., Naples, FL, USA) Their loop can be tightened and adjusted according to the tunnel length during the surgical process, thereby decreasing the possibility of bungee cord effect [3, 5, 6]
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