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Comparative Study
, 10 (2), 157-166

Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- And Adjustable-Length Loop Cortical Fixation

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Comparative Study

Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- And Adjustable-Length Loop Cortical Fixation

Jin Hwan Ahn et al. Clin Orthop Surg.

Abstract

Background: Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. The purpose of this study was to compare graft healing in the femoral tunnel, implant-related failure, and clinical results between fixed- and adjustable-length loop devices in outside-in ACL reconstruction.

Methods: A total of 109 patients who underwent ACL reconstruction using the outside-in technique from December 2010 to July 2014 were included. For femoral graft fixation, a fixed-length loop device was used in 48 patients (fixed-loop group) and an adjustable-length loop device was used in 61 patients (adjustable-loop group). For evaluation of graft healing in the femoral tunnel, magnetic resonance imaging was performed at postoperative 6 months and the signal-to-noise ratios (SNRs) of the tendon graft and tendon-bone interface in the femoral bone tunnel were evaluated. The presence of synovial fluid was evaluated to determine loop lengthening at the femoral tunnel exit. Clinical results assessed using International Knee Documentation Committee score, Tegner-Lysholm Knee Scoring scale, and knee instability tests were compared between groups.

Results: The SNRs of the tendon graft and tendon-bone interface were not statistically different between groups. The presence of synovial fluid at the femoral exit showed no statistical difference between groups. Clinical results were not significantly different between groups.

Conclusions: The adjustable-length loop device provided comparable graft healing, implant-related failure, and clinical results with the fixed-length loop device, allowing adaptation of the graft to the different tunnel lengths. Therefore, it could be effectively used with an adjustment according to the femoral tunnel length.

Keywords: Anterior cruciate ligament; Femoral tunnel; Graft healing; Suspensory fixation device.

Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Patient flowchart. ACL: anterior cruciate ligament.
Fig. 2
Fig. 2. Postoperative X-ray. (A) Fixedlength loop device. (B) Adjustable-length loop device.
Fig. 3
Fig. 3. Coronal oblique T2-weighted magnetic resonance imaging. (A) Presence of synovial fluid case. (B) Absence of fluid case. Arrow: presence of synovial fluid at the exit of femoral tunnel.
Fig. 4
Fig. 4. Signal intensity of anterior cruciate ligament graft using the signal-to-noise quotient. (A) Tunnel aperture. (B) Tunnel midsection. (C) Tunnel exit. Arrow: tendon-bone interface, arrowhead: tendon graft.
Fig. 5
Fig. 5. A wide gap between the graft end and the exit of the femoral bone tunnel. Arrow: length of wide gap.

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