Abstract
PurposeTo compare loop elongation after 5000 cycles, loop-elongation at failure, and load at failure of the fixed-loop G-Lok device and three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT), during testing over extended cycles under high loading.MethodsFive devices of each type were tested on a custom-built rig fixed to an Instron machine. The testing protocol had four stages: preloading, cyclic preconditioning, incremental cyclic loading and pull-to-failure. Outcome measures were loop elongation after 5000 cycles, loop-elongation at failure, and load at failure.ResultsThe loop elongation after 5000 cycles for G-Lok was 1.46 ± 0.25 mm, which was comparable to that of RigidLoop (1.51 ± 0.16 mm, p = 1.000) and ProCinch (1.60 ± 0.09 mm, p = 1.000). In comparison, the loop elongation for UltraButton was 2.66 ± 0.28 mm, which was significantly larger than all other devices (p = 0.048). The failure load for all devices ranged between 1455 and 2178 N. G-Lok was significantly stronger than all adjustable-loop devices (p = 0.048). The elongation at failure was largest for UltraButton (4.20 ± 0.33 mm), which was significantly greater than G-Lok (3.17 ± 0.33 mm, p = 0.048), RigidLoop (2.88 ± 0.20 mm, p = 0.048) and ProCinch (2.78 ± 0.08 mm, p = 0.048). There was no significant difference in elongation at failure for the rest of the devices.ConclusionsOur study has shown that the G-Lok fixed-loop device and the three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT) all elongated less than 3 mm during testing over an extended number of cycles at high loads, nonetheless, the fixed loop device performed best in terms of least elongation and highest load at failure.
Highlights
Symptomatic knee instability after anterior cruciate ligament (ACL) injury may require reconstruction of the ACL with an auto- or allo- graft, which is fixed to theThe more recent cortical suspension adjustable-loop devices have several advantages: (1) they are easier to use in short femoral tunnels, with placement throughSingh et al Journal of Experimental Orthopaedics (2020) 7:27 the antero-medial arthroscopic portal; (2) they allow more of the femoral tunnel to be filled with graft, and shorter graft lengths can be used, as seen with tripling/ quadrupling of the graft; (3) they are suitable for most tunnel sizes, eliminating the need for fixed-loop devices with different loop sizes [9, 14, 16, 18]
The loop elongation for the UltraButton was 2.66 ± 0.28 mm, which was significantly larger than all other devices (p = 0.048)
The G-Lok fixed-loop device was significantly stronger than all adjustable-loop devices (p = 0.048), while ProCinch RT was significantly weaker than all other devices (p = 0.048) and there was no significant difference between UltraButton and RigidLoop Adjustable (p = 0.690)
Summary
Symptomatic knee instability after anterior cruciate ligament (ACL) injury may require reconstruction of the ACL with an auto- or allo- graft, which is fixed to theThe more recent cortical suspension adjustable-loop devices have several advantages: (1) they are easier to use in short femoral tunnels, with placement throughSingh et al Journal of Experimental Orthopaedics (2020) 7:27 the antero-medial arthroscopic portal; (2) they allow more of the femoral tunnel to be filled with graft, and shorter graft lengths can be used, as seen with tripling/ quadrupling of the graft; (3) they are suitable for most tunnel sizes, eliminating the need for fixed-loop devices with different loop sizes [9, 14, 16, 18]. Studies show that cortical suspension fixed-loop devices elongate less than adjustable-loop devices, the latter has been shown to elongate by more than 3 mm, which introduces knee instability and is regarded as a clinical failure [13, 19]. The aim of this study was to compare the loop elongation after 5000 cycles, the loopelongation at failure, and the load at failure of the fixedloop G-Lok device and three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT), during testing over an extended number of cycles under high loading. The authors hypothesised that the fixedloop device would have a lower elongation after 5000 cycles and at failure, as well as a higher failure load, than the adjustable-loop devices
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