Radiologic and Clinical Outcomes After Hamstring Anterior Cruciate Ligament Reconstruction Using an Adjustable-Loop Cortical Suspension Device With Retensioning and Knot Tying

Abstract

To report magnetic resonance imaging (MRI) findings and clinical outcomes after anterior cruciate ligament reconstruction using an adjustable-loop device (ALD) with retensioning and knot tying. The inclusion criteria were patients who underwent hamstring anterior cruciate ligament reconstruction using an ALD with retensioning and knot tying between May and December 2015 and were followed up for a minimum of 2years. The exclusion criteria were patients with combined ligament injury, revision surgery, or reinjury after reconstruction. After initial tightening of the adjustable loop, retensioning and knot tying were performed and the graft was fixed at the tibia. Multiplanar reformatted images of 3-T MRI scans were obtained on the immediate postoperative day and at 6months after surgery to measure the gap between the top of the graft and the top of the femoral tunnel (i.e., tunnel-graft gap). Differences in the tunnel-graft gap between the immediate postoperative day and 6months after surgery (i.e., gap difference) were calculated and correlated with knee stability and functional outcomes. Thirty-six patients were enrolled in this study. The mean tunnel-graft gap was 2.1 ± 2.8mm on the immediate postoperative day and 4.6 ± 3.5mm at 6months after surgery (P < .001). The mean gap difference was 2.5 ± 2.0mm. The mean KT-1000 measurement was 1.5 ± 2.2mm, and mean Lysholm score and Tegner activity scale score were 93.6 ± 5.5 and 5.6 ± 1.5, respectively. The gap difference correlated negatively with the follow-up Lysholm score (P= .004); however, knee stability and the Tegner activity scale score were not correlated. Although the ALD was secured by retensioning and knot tying, MRI showed that the graft was not fully inserted in some patients and the tunnel-graft gap increased at 6months' follow-up. The increase in the tunnel-graft gap did not correlate with knee stability or the Tegner activity scale score but correlated negatively with the Lysholm score. Level IV, therapeutic case series.