Clin Orthop Surg.  2018 Jun;10(2):157-166. 10.4055/cios.2018.10.2.157.

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

  • 1Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Barunbone Hospital, Seoul, Korea.
  • 3Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.


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.
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.
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.
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.


Anterior cruciate ligament; Femoral tunnel; Suspensory fixation device; Graft healing
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