Title : Comparison of fixed- and variable-loop button fixation in arthroscopic anterior cruciate ligament reconstruction
Abstract:
INTRODUCTION: Graft fixation and incorporation into bony tunnels are of utmost importance for stability of the reconstructed knee. With the advent of fixed loop and variable loop suspensory fixation devices, maximum amount of graft can be placed within the femoral tunnel. Although several biomechanical studies have been conducted comparing these two devices, there are very few comparative clinical studies.
AIMS & OBJECTIVES: The primary objective of this study was to compare the functional outcomes of arthroscopic ACL reconstruction with fixed and variable loop devices by determining their effect on graft laxity, assessed clinically, and patient-reported outcome scores. The secondary objective was to evaluate the demographic distribution, mode and MRI grading of ACL injuries and assess the pattern of associated injuries.
METHODOLOGY: Out of 32 patients (27 males and 5 females) who underwent primary ACL reconstruction using doubled or tripled hamstring autograft, fixed and variable loop devices were used for 13 and 19 patients, respectively. 13 patients in each group were evaluated at 2 weeks, 4 weeks, 6 weeks, 3 months, 6 months and 1 year follow-up post-operatively using Lysholm knee score. 6 patients in the variable loop group had only 6 months follow-up. Anterior drawer and Lachman tests for ligament laxity were performed at 6 months and 1 year follow-up.
RESULTS: Mean ages of patients in the fixed and variable loop groups were 34.5 + 11 and 34.1 + 9.1 years, respectively. Lysholm knee score at 6 weeks was fair in 7.7% of the patients in the fixed loop group as compared to 52.6% of those in the variable loop group (p<0.05). All the other parameters were comparable between the two groups. 1 patient in each group had ligament laxity at 6 months and 1 year follow-up.
CONCLUSION: This study showed no statistically significant difference in graft laxity or functional outcomes of arthroscopic ACL reconstruction with fixed and variable loop devices, except for a better patient-reported outcome score in the variable loop group at 6 weeks follow-up. Hence, there is a need for more comparative studies in this direction.
KEYWORDS: arthroscopic ACL reconstruction, fixed loop device, variable loop device
What will audience learn from my presentation?
1. How fixed-loop compares with variable-loop button fixation in arthroscopic ACL reconstruction in terms of graft laxity, assessed clinically, and patient-reported outcome scores
2. The demographic distribution, mode and MRI grading of ACL injuries and pattern of associated injuries.
3. This research would help orthopaedic surgeons make an informed decision about the kind of fixation device that they could use in ACL reconstruction.
4. More studies could be performed in this direction to obtain more information on whether one fixation device is clearly superior to the other one.
