COMPARATIVE FUNCTIONAL OUTCOMES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING A QUADRUPLED HAMSTRING TENDON AUTOGRAFT WITH FIXED-LOOP VERSUS ADJUSTABLE-LOOP FEMORAL CORTICAL SUSPENSION

Abstract

Background: Femoral fixation of soft-tissue grafts using cortical suspension has become an established component of arthroscopic anterior cruciate ligament (ACL) reconstruction. Fixed-loop constructs have a preset loop dimension, whereas adjustable-loop constructs permit alteration of loop length during the procedure. Although laboratory investigations have identified mechanical differences between these systems, it remains uncertain whether such differences result in clinically detectable differences in postoperative recovery [7,9-13]. Methods: A hospital-based observational study was undertaken involving 30 patients, aged 20–60 years, with ACL injury confirmed by clinical assessment and imaging. All participants underwent arthroscopic reconstruction using a quadrupled hamstring tendon autograft [1,5]. Femoral fixation was performed with a fixed-loop device in 15 patients and an adjustable-loop device in the remaining 15. Patient-reported knee function was assessed using the International Knee Documentation Committee (IKDC) subjective score and Lysholm score [2-4]. Evaluations were obtained before reconstruction and subsequently at 3 months, 6 months, and 12 months. Anterior knee stability was evaluated clinically using Lachman grading, and complications occurring during follow-up were recorded. Results: Both fixation groups showed progressive gains in functional scores following surgery. In patients treated with the fixed-loop device, the mean IKDC score increased from 48.0 ± 5.8 at baseline to 63.0 ± 6.2 at 3 months, 71.5 ± 6.8 at 6 months, and 75.8 ± 6.9 at 12 months. The corresponding measurements in the adjustable-loop group were 47.6 ± 5.5, 63.2 ± 6.5, 72.0 ± 6.9, and 77.1 ± 7.2. Lysholm scores in the fixed-loop group increased from 48.7 ± 6.1 before surgery to 65.2 ± 6.8, 73.9 ± 7.1, and 79.8 ± 7.5 at the three subsequent assessments. In the adjustable-loop group, the values were 50.1 ± 6.5, 66.5 ± 7.2, 74.5 ± 7.4, and 80.9 ± 7.8, respectively. None of the between-group comparisons demonstrated statistical significance at the reported assessment points (P > 0.05). Lachman grading improved from grade II before surgery to grade I after reconstruction in all 30 participants. No postoperative complication was documented during the observation period. Conclusion: Within this 30-patient cohort, either form of femoral cortical suspension was associated with improved subjective knee function and restoration of clinical anterior stability following ACL reconstruction with a quadrupled hamstring autograft. Neither fixation strategy demonstrated a measurable functional advantage over the other. Interpretation is limited by the small cohort and duration of follow-up; adequately powered prospective studies incorporating quantitative laxity assessment and longer observation are required.