Zion Nego, Das Tapan K, Mishra Jitendra, Mishra Spandan, Agnihotri Shishir
Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND.
Cureus. 2024 Nov 10;16(11):e73411. doi: 10.7759/cureus.73411. eCollection 2024 Nov.
This study aims to evaluate the effects of adjustable- and fixed-loop femoral endobuttons on intraoperative surgeon satisfaction and postoperative patient functional outcomes in anterior cruciate ligament (ACL) reconstruction. The use of cortical suspensory devices, either fixed-loop or adjustable-loop, is common in ACL reconstruction surgeries for femoral tunnel fixation. Fixed-loop devices, although effective, often require additional tunnel drilling, potentially leading to tunnel widening. Adjustable-loop devices were introduced to mitigate this issue. However, there are concerns regarding the mechanical performance of adjustable loops, particularly under cyclical loading, which could affect long-term graft stability.
This retrospective comparative study compares functional outcomes and intraoperative assessments of 140 patients who underwent ACL reconstruction between 2017 and 2021 with fixed-loop and adjustable-loop devices for the femoral side. Patients were evaluated at six weeks, six months, one year, and two years postoperatively using the Lysholm score, International Knee Document Committee score, Tegner activity scores, and knee stability tests, including Lachman and anterior drawer tests. Additionally, the study captured surgeon satisfaction intraoperatively and compared it with the final functional outcome.
Both groups demonstrated significant improvements in knee stability, range of motion (ROM), and functional scores over time. At six weeks, the anterior drawer test showed 61 stable knees out of 70 in the adjustable-loop group and 57 of 70 in the fixed-loop group, with stability maintained in 56 and 49 knees, respectively, at the final follow-up. The mean extension at two years was 0.5° ± 3.8° in the fixed-loop group and -1.3° ± 3.2° in the adjustable-loop group (p = 0.02). Although the adjustable-loop group showed trends toward better early knee stability and extension, these differences were not statistically significant at two years (p > 0.05).
Surgeons' intraoperative satisfaction with graft firmness was higher in the adjustable-loop group. However, this did not correlate with long-term functional outcomes, as both groups had comparable scores at the final follow-up. Further research with larger sample sizes and extended follow-up periods is needed to confirm these findings. The limitations of this study include its retrospective design, the potential for selection bias, and the subjective nature of intraoperative assessments.
本研究旨在评估可调式和固定式袢股骨端钮在前交叉韧带（ACL）重建术中对术者满意度及术后患者功能结局的影响。在ACL重建手术中，使用皮质悬吊装置（无论是固定袢还是可调袢）进行股骨隧道固定很常见。固定袢装置虽然有效，但通常需要额外钻孔，这可能导致隧道扩大。可调袢装置的引入是为了缓解这一问题。然而，人们担心可调袢的力学性能，特别是在循环载荷下，这可能会影响移植物的长期稳定性。
本回顾性比较研究比较了2017年至2021年间接受ACL重建的140例患者使用固定袢和可调袢装置进行股骨侧固定后的功能结局和术中评估情况。术后6周、6个月、1年和2年时，使用Lysholm评分、国际膝关节文献委员会评分、Tegner活动评分以及膝关节稳定性测试（包括Lachman试验和前抽屉试验）对患者进行评估。此外，该研究记录了术者术中的满意度，并将其与最终功能结局进行比较。
随着时间的推移，两组患者的膝关节稳定性、活动范围（ROM）和功能评分均有显著改善。在6周时，可调袢组70例中有61例膝关节在前抽屉试验中表现稳定，固定袢组70例中有57例稳定；在最终随访时，可调袢组和固定袢组分别有56例和49例膝关节保持稳定。固定袢组在2年时的平均伸直角度为0.5°±3.8°，可调袢组为-1.3°±3.2°（p = 0.02）。尽管可调袢组在早期膝关节稳定性和伸直方面有更好的趋势，但在2年时这些差异无统计学意义（p>0.05）。
可调袢组术者对移植物牢固程度的术中满意度更高。然而，这与长期功能结局并无关联，因为两组在最终随访时的评分相当。需要进行更大样本量和更长随访期的进一步研究来证实这些发现。本研究的局限性包括其回顾性设计、存在选择偏倚的可能性以及术中评估的主观性。
