Outcome analysis of Adjustable Loop Device for ACL femoral fixation

Background: Arthroscopic anterior cruciate ligament reconstruction is commonly performed to restore knee stability after ACL rupture. Femoral graft fixation remains a critical factor influencing graft healing, knee stability, functional recovery, and long-term outcome. Adjustable-loop cortical suspension devices allow intraoperative loop shortening and graft retensioning after tibial fixation, potentially improving graft seating within the femoral socket. However, concerns remain regarding loop elongation, graft-tunnel gap, and postoperative laxity. Objective: To evaluate the clinical, functional, and radiological outcomes of adjustable-loop device fixation for femoral-side graft fixation in patients undergoing arthroscopic ACL reconstruction. Materials and Methods: This outcome analysis was derived from the adjustable-loop arm of a clinical study conducted among patients undergoing arthroscopic ACL reconstruction using hamstring tendon graft. Thirty patients treated with an adjustable-loop device for femoral fixation were included. Patients were evaluated clinically using Lachman test and pivot shift test at preoperative assessment and at 3, 6, and 12 months postoperatively. Functional outcomes were assessed using Lysholm knee score and International Knee Documentation Committee score preoperatively and at 6, 9, and 12 months. Graft and tunnel-related parameters were recorded, including graft thickness, graft length, femoral tunnel length, tibial tunnel length, and postoperative MRI-based loop measurements. Results: The adjustable-loop group included 30 patients with a mean age of 25.9 ± 4.27 years. Males constituted 26 cases and females 4 cases. Mean graft thickness was 8.6 ± 0.45 mm, mean graft length was 85.76 ± 2.88 mm, mean femoral tunnel length was 37.3 ± 2.16 mm, and mean tibial tunnel length was 49.93 ± 2.90 mm. Preoperatively, all patients had Grade 3 Lachman test positivity. At 12 months, 24 patients had Grade 1 Lachman and 6 had Grade 2 Lachman, with no Grade 3 Lachman positivity. Pivot shift test improved from preoperative Grade 1 in 5 patients, Grade 2 in 15 patients, and Grade 3 in 10 patients to negative pivot shift in 23 patients at 12 months. Mean Lysholm score improved from 76.53 ± 5.0 preoperatively to 91.73 ± 1.69 at 12 months. Mean IKDC score improved from 64.77 ± 5.40 preoperatively to 79.73 ± 2.86 at 12 months. MRI evaluation showed an increase in mean loop length from 17.76 ± 0.48 mm at early postoperative assessment to 19.36 ± 0.45 mm at 6 months. Conclusion: Adjustable-loop femoral fixation in ACL reconstruction showed satisfactory clinical and functional outcomes at one-year follow-up. Significant improvement was observed in knee stability, Lysholm score, and IKDC score. Although MRI demonstrated mild loop elongation and increase in tunnel-graft gap over time, these radiological changes did not appear to compromise functional recovery. Adjustable-loop devices may be considered clinically effective for femoral fixation in ACL reconstruction when proper graft retensioning and surgical technique are followed.