Varying femoral-sided fixation techniques in anterior cruciate ligament reconstruction have similar clinical outcomes: a network meta-analysis

Lower button-cortex distance and lower revision rates with adjustable-loop compared to fixed-loop cortical suspension devices for anterior cruciate ligament reconstruction

Purpose

To compare button position following femoral fixation of an anterior cruciate ligament (ACL) graft using fixed-loop cortical suspension device vs. an adjustable-loop device. Subsequently, to assess the association of button position-related factors and revision ACL reconstruction.

Methods

This was a retrospective cohort study of consecutive patients undergoing ACL reconstruction using fixed-loop (Endobutton CL) and adjustable-loop cortical suspension device (Ultrabutton) for femoral fixation in a single institution between 2009 and 2022. Demographic and operative characteristics were recorded. To assess soft tissue interposition the distance between the button and the lateral femoral condyle (LFC) was measured on X-rays made on the first post-operative day. Other measurements included button angle, relative position (anterior/middle/posterior), and button migration (assessed using most recent X-rays).

Results

Overall, 244 patients were included in the study. 59% of patients in the fixed-loop group and 41% in the adjustable-loop group. Hamstrings autograft was utilised most commonly (91%), while the rest of the procedures included allografts. A significantly shorter button distance from the LFC was noted in the post-operative Antero-posterior (AP) X-ray of the adjustable-loop button, 0.44 ± 0.52 mm versus 0.72 ± 0.84 mm, respectively (p = 0.002). Revision rates were significantly lower in the adjustable-loop group (4%) versus the fixed-loop group (12%, p = 0.035). No statistically significant direct association was found between button distance from the LFC and revision ACL reconstruction.

Conclusions

Adjustable-loop cortical suspension devices for femoral fixation of an ACL reconstruction were associated with lower revision rates and a lower button-LFC distance when compared to fixed-loop devices.

Level of Evidence

Level III, retrospective comparative cohort study.

Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction-A discussion

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction (ACLR), with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques. The paper explores and comments on a recently published review by Dai et al, titled "Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR", while providing insight into its relevance within the field of ACLR, and recommendations for future research.