Clinical outcomes of three different technique using and adjustable femoral loop fixation in arthroscopic anterior cruciate ligament reconstruction

Objective: In our study, it was aimed to compare the effects of clinical and functional results of different graft tensions provided by three different fixation methods of the adjustable femoral loop used in anterior cruciate ligament reconstructions. Materials and Methods: This study was planned and conducted as a randomized, single-blind, clinical-based and prospective cohort. Patients with ACL ruptured who underwent ACL reconstruction using an adjustable-loop cortical suspansory devices for femoral side fixation with the anteromedial portal technique in the Orthopedics and Traumatology Clinic of Faculty of Medicine, Istanbul University, between 2018 and 2020 were prospectively included in the study. 36 cases were randomized into 3 groups according to the inclusion criteria and the chosen method to be applied. Preoperative and postoperative physical examination and clinical evaluations of the cases (such as IKDC scores, Lysholm scores , KT-1000 measurements) were performed. The p<0.05 value was accepted as significant in the statistical evaluation of the data. Results: As of total, 26 of the 30 subjects in the study were male and 4 were female. 9 out of 10 cases in the standart (S) group were male (90%), 1 was female, 8 out of 10 cases in the retensioning group (SG) were male (80%) and 2 were female (20%), and 9 out of 10 cases in the retensioning + knot-tying (SG-D) group, were male (90%), 1 was female. The mean age of the cases was 27.4±8.08 (range: 18-50). In IKDC scores of this study, although it was determined that the functional scoring results of the S, SG, SG-D groups, both preoperatively and postoperatively increased significantly in favor of postoperative (p = 0.0001), it was determined that the postoperative score means of the SG and SG-D groups were slightly higher than the S group (88.8, 94.9, 94.6, respectively).Although it was observed that the translational measures of the opposite knee were decreased in the SG and SG-D groups, where the graft tension was greater, especially in the (89 N) and (134 N) forces , there was no statistically significant difference between the groups (p>0.05) (SG: Δ89: 1.6mm, Δ134:1,2mm) (SG-D: Δ89:1.8mm, Δ134:1,3mm) Conclusion: It can be suggested that the retensioning method is both simple and effective approach in terms of minimizing the graft laxity and providing the optimal environment in the for the ligamentization of the graft. In addition, it can also be suggested that the knot-tying technique with the retensioning are potentially promising in order to limit the slippage of the graft, which can be caused by adjustable loop cortical suspensory devices.