A Comparative Biomechanical Study of Femoral Cortical Suspension Devices for Soft-Tissue Anterior Cruciate Ligament Reconstruction: Adjustable-Length Loop Versus Fixed-Length Loop

Purpose: To determine whether there are differences between adjustable-length loop and fixed-length loop devices in terms of the amount of displacement, temporal pattern of displacement, and ultimate failure load when tested using 4,500 cycles of sinusoidal loading with high loads (100-400 N). Methods: Two cortical suspension devices with a fixed- or adjustable-length loop were tested. For our comparisons, a 20-mm fixed-length loop device and a fixed-length loop device with the same loop length were used. Comparisons between the devices used both a device-only model (DOM) and a device–bone–soft-tissue graft construct model (CM). Results: In the DOM, the adjustable-length loop device showed weaker mechanical properties. Mean cumulative peak displacement was 1.91 mm for the adjustable-length loop device and 0.74 mm for the fixed-length loop device (P =.001). The displacement of the adjustable-length loop device increased between 1,000 and 4,500 cycles; in contrast, that of the fixed-length loop device reached a plateau. However, there was never displacement greater than 3 mm. In addition, the adjustable-length loop device showed a weaker ultimate failure load (925 N vs 1,410 N, P =.001). In the CM, the difference in cumulative peak displacement between the 2 groups decreased and did not reach statistical significance. The displacement of both devices showed a similar pattern. In addition, there was no difference in ultimate failure load between the 2 groups. Conclusions: There was no significant difference in terms of total displacement, temporal pattern of displacement, and ultimate failure load between the 2 devices in the CM, which is the more clinically relevant model. Furthermore, even in the DOM, the difference in total displacement was small and did not reach a clinically meaningful level. Therefore, both devices can be used effectively during anterior cruciate ligament reconstruction with soft-tissue graft. Clinical Relevance: Both femoral cortical suspension devices with adjustable- and fixed-length loops can be used with similar mechanical properties during anterior cruciate ligament reconstruction.