ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #717

 

Fixed- versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Biomechanical Studies

Darby A. Houck, BA, Boulder, CO UNITED STATES
Matthew J. Kraeutler, MD, Cedar Grove, NJ UNITED STATES
Eric C. McCarty, MD, Boulder, CO UNITED STATES
Jonathan T. Bravman, MD, Denver, CO UNITED STATES

University of Colorado School of Medicine, Dept. of Orthopaedics, Division of Sports Medicine and Shoulder Surgery, Aurora, CO, UNITED STATES

FDA Status Not Applicable

Summary

Current biomechanical data suggest that the ToggleLoc with Ziploop device is the strongest fixation device at “time-zero” in terms of ultimate load to mechanical failure. However, the Endobutton CL device demonstrated the least cyclic displacement, which may be a more clinically applicable measure of device superiority.

Abstract

Purpose

The purpose of this study was to compare biomechanical results of fixed- versus adjustable-loop femoral cortical suspensory devices in studies simulating anterior cruciate ligament reconstruction (ACLR).

Methods

Two independent reviewers searched PubMed, Embase, and the Cochrane Library to find studies comparing the biomechanical strength of fixed- and adjustable-loop cortical suspension devices for ACLR using isolated device and/or specimen set-ups using porcine femora and bovine flexor tendons. Studies that compared both devices with similar biomechanical methods were included. Data extracted included displacement during cyclic loading, ultimate load to failure, and modes of failure of the different cortical suspensory devices for ACLR.

Results

Six studies were identified that met the inclusion criteria, including a total of 76 fixed-loop devices and 120 adjustable-loop devices. Load to failure was significantly different (p < 0.0001), with the strongest fixation device being the ToggleLoc with Ziploop adjustable-loop device (1443.9 ± 512.3 N), compared to the EndoButton CL fixed-loop device (1312.9 ± 258.1 N; p = 0.04) and the TightRope RT adjustable-loop device (863.8 ± 64.7 N; p = 0.01). Displacement was significantly different, with Endobutton CL (3.7 ± 3.9 mm) showing the least displacement, followed by ToggleLoc with Ziploop (4.9 ± 2.3 mm) and TightRope RT (7.7 ± 11.1 mm) (p < 0.0001).

Conclusions

Current biomechanical data suggest that the ToggleLoc with Ziploop device is the strongest fixation device at “time-zero” in terms of ultimate load to mechanical failure. However, the Endobutton CL device demonstrated the least cyclic displacement, which may be a more clinically applicable measure of device superiority.