According to recently published results, good clinical and radiological
outcomes were seen with both fixed and adjustable loop cortical suspension
devices in ACL reconstruction. No significant differences were seen with
regard to synovial coverage and rupture of the graft with second-look
arthroscopy.
Researchers identified 79 patients who underwent ACL reconstruction. Of
these patients, 41 underwent surgery with a fixed loop (EndoButton) device
and 38 patients had surgery with an adjustable loop (TightRope) device.
The groups were compared for Lysholm knee scores, Lachman test, pivot-shift
test, anterior stress radiographs and femoral tunnel widening on plain
radiographs. Second-look arthroscopy was used in 27 fixed loop patients
and in 21 adjustable loop patients.
Results showed improvements in both groups at final follow-up for the mean
Tegner activity, Lysholm and IKDC scores, However, there were no statistically
significant differences between groups. Groups were not statistically
significantly different with regard to Lachman test scores, pivot-shift
test scores or anterior stress radiographs. No significant differences
were seen in radiologic measurements that compared the femoral tunnel
widening at the proximal and distal half. No differences were seen in
graft tear and synovial coverage after second-look arthroscopy. –
by Monica
The goals of ACL reconstruction are a full return to sports and minimal
failure rates. ACL reconstruction uses a graft as a scaffold that serves
as a dynamic bridge between tunnels in the femur and the tibia. A lack
of stable fixation coupled to motion can result in osteoclastic osteolysis
and tunnel widening. Ahn and colleagues evaluated two methods of fixation
during ACL reconstruction in 91 patients using autograft hamstrings with
the objective to minimize widening of the tunnels and clinical success.
In the femur, they compared the suspensory fixation technique of the endo
button to the tight rope with biodegradable screws and a screw and washer
in the tibia. They found that there were no differences in patient-reported
outcomes, objective stability or tunnel widening. In this study, the clinical
measurements were well accepted. In contradistinction, the X-ray technique
used has not been validated as previous studies have measured tunnel widening
accurately using CT scan. Consequently, the conclusions that these technologies
are equal are called into question and are invalid. What we do know is
that the use of bone grafts and biodegradable screws with aperture fixation
are proven adjuncts to optimize healing of the ACL graft and bone tunnels
with or without suspensory fixation - by
Bert R. Mandelbaum, MD