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Additional tying on the adjustable-loop device improves the outcomes of anterior cruciate ligament reconstruction using hamstring autograft

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  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to verify the efficacy of a novel technique for additional tying on the adjustable-loop device to prevent stress concentration on the graft loop end and gradual loop lengthening.

Methods

A total of 124 patients who underwent anterior cruciate ligament reconstruction using hamstring autografts from 2014 to 2017 were included in this retrospective study. After 1:1 propensity score matching, two groups were formed (group I: 50 patients without tying vs. group II: 50 patients with tying). Anterior laxity was evaluated using side-to-side differences. Tunnel length, loop length, and graft-tunnel gap were measured using follow-up magnetic resonance imaging. The signal-to-noise ratio was calculated at the loop end, loop inner side, tunnel entrance, and graft mid-substance. The clinical outcomes were assessed using the International Knee Documentation Committee score, Lysholm score, pivot shift test, and Lachman test.

Results

The average follow-up period was 63.2 ± 4.8 and 53.8 ± 11.9 months in groups I and II, respectively. Anterior laxity showed that side-to-side differences improved significantly 6 months postoperatively in both the groups. Although the anterior laxity improved in group II (2.9 ± 1.0 to 1.6 ± 0.8, p < 0.001), it deteriorated in group I (2.5 ± 1.5 to 3.3 ± 1.3 mm, p < 0.001) at the final follow-up. The graft-tunnel gap was significantly larger in group I (p < 0.001). The signal-to-noise ratios of the loop end and loop inner side were significantly higher in group I (p < 0.001 and p = 0.020, respectively). The clinical outcomes at the final follow-up were not significantly different between the groups.

Conclusion

The additional tying on the adjustable-loop device was not superior to the control group in clinical stability examination or outcome. However, it was effective in anterior laxity measured by stress radiographs, preventing stress on the adjustable-loop device, and gradual graft loop lengthening.

Level of evidence

Level III.

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Abbreviations

ALD:

Adjustable-loop device

SNR:

Signal-to-noise ratio

ACLR:

Anterior cruciate ligament reconstruction

BMI:

Body mass index

MRI:

Magnetic resonance imaging

DICOM:

Digital image communication in medicine

ROI:

Region of interest

IKDC:

International Knee Documentation Committee

ANOVA:

Analysis of variance

ICC:

Intra-class correlation coefficient

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Han Gyeol Choi, Ho Won Jeong, Sung Bae Park, Seung Jae Shim & Yong Seuk Lee

  2. Department of Orthopedic Surgery, Nalgae Hospital, Seoul, South Korea

    Han Gyeol Choi

Authors
  1. Han Gyeol Choi
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  2. Ho Won Jeong
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  3. Sung Bae Park
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Contributions

HGC and HWJ participated in study design and drafted the manuscript, HGC performed the statistical analysis, SBP and SJS collected the data and contributed to performing statistical analysis, YSL conceived of the study, participated in coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yong Seuk Lee.

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The authors declare that we have no conflict of interest.

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Institutional Review Board approval was obtained before performing the study (B-2012-652-108).

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Choi, H.G., Jeong, H.W., Park, S.B. et al. Additional tying on the adjustable-loop device improves the outcomes of anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 30, 3673–3680 (2022). https://doi.org/10.1007/s00167-022-06936-1

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  • DOI: https://doi.org/10.1007/s00167-022-06936-1

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