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Orthopedics Today Interviews Dr. Mandelbaum About If Fixed, Adjustable Loop Devices Lead to Good ACL Reconstruction Results

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