Evaluation of the results of anterior cruciate ligament reconstruction using adjustable femoral cortical suspensory fixation device

Background
The anterior cruciate ligament (ACL) injury is considered the most common ligamentous injury in the knee. As a result, reconstruction of the torn ACL becomes a common surgical procedure for orthopedic surgeons, especially those who are interested in sports medicine.
Objective
This study aims to evaluate the results of ACL reconstruction (ACLR) using adjustable-loop fixation device for the femur and an interference screw for the tibia. Evaluation will be done using Lysholm knee score and the international knee documentation committee (IKDC) score, and by the assessment of the femoral tunnel diameter changes after a follow-up period of 12 months.
Methods
Twenty patients in whom the torn ACL had been reconstructed arthroscopically using transportal technique with an ipsilateral hamstring tendon. All ACLR operations were done by the same surgeon in the orthopedic department at Fayoum university hospital and Abu-Qir insurance hospital during March 2021, and the follow-up period started in April 2021 and ended in April 2022 with an overall follow-up period of 12 months. An adjustable femoral cortical suspensory fixation device was used and the tibial fixation was done using an interference screw. Postoperatively, all patients were evaluated objectively using the anterior drawer test, Lachman test, and pivot-shift test. The subjective evaluation was performed using Lysholm knee score and the IKDC score. To evaluate femoral tunnel changes, a computer tomography (CT) scan was done at four different levels immediately postoperative and after 12 months postoperative.
Results
The selected patients were homogenous at baseline regarding age, Sex, dominance, and disease duration. As regards preoperative examination, the Anterior drawer test and the Lachman test were positive in all patients (100%), while the Pivot-shift test was positive in only 9 patients (45%), but positive in all patients (100%) after anesthesia. After 12 months post-surgery, all patients were reexamined again using the same tests and we found that all tests were negative in all patients. Patients were subjectively evaluated using both Lysholm Knee Score and IKDC score. Preoperatively, the patients’ Lysholm score ranged from (49%–74%) with Mean equals (62.3 ± 8.71), and the final Lysholm score after 12 months ranged from (85%–100%) with Mean equals (97.2 ± 4.09). The patients’ IKDC score preoperatively ranged from (20.6%–85%) with Mean equals (56.33 ± 17.03), and the final IKDC score after 12 months ranged from (96.5%–100%) with Mean equals (99.5 ± 1.09). So, there was a statistically significant improvement in the objective and subjective clinical outcome measures. As regards the femoral tunnel diameter changes, we noticed that there was some widening in accordance with F1 (5.46%±1.06), F2 (8.39%±0.67), F3 (7.12%±0.93), and F4 (7.23%±0.82), but there was no correlation between femoral tunnel diameter changes and the IKDC score changes nor the overall improvement in functional outcomes.
Conclusion
In transportal ACLR, the use of adjustable-loop fixation device on the femoral side, may lead to favorable clinical and radiological results regardless of femoral tunnel widening.