Adjustable Loop Fixation in Multi-ligament Knee Injuries: A Technical Note

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Sports Medicine

Background:

• Adjustable Loop Fixation devices (ALDs) were developed to provide graft length adjustability within bone tunnels.
• ALDs have demonstrated comparable clinical and biomechanical outcomes to traditional methods in anterior cruciate ligament reconstructions.
• The utility of ALDs in complex multi-ligament knee reconstructions is increasingly recognized.

Purpose of the Study:

• To evaluate the application and benefits of ALDs in various multi-ligament knee reconstruction procedures.
• To highlight the role of ALDs in achieving differential tensioning for complex ligamentous repairs.
• To demonstrate how ALDs facilitate graft tensioning and re-tensioning to optimize reconstruction stability.

Main Methods:

• Application of ALDs in double bundle posterior cruciate ligament reconstruction, allowing differential tensioning of distinct graft bundles.
• Utilizing ALDs in modified LaPrade technique for anatomic posterolateral corner reconstruction for differential tensioning of collateral ligaments and associated structures.
• Employing ALDs in anatomic superficial medial collateral ligament reconstruction for femoral-sided tensioning, cyclic loading, and re-tensioning.

Main Results:

• ALDs enable differential tensioning of anterolateral and posteromedial bundles in double bundle PCL reconstruction.
• ALDs facilitate differential tensioning of fibular collateral ligament and popliteus complex in posterolateral corner reconstruction.
• ALDs allow for effective tensioning, cycling, and re-tensioning in superficial MCL reconstruction, leading to stable outcomes.

Conclusions:

• Adjustable Loop Fixation devices offer significant advantages in multi-ligament knee reconstructions.
• ALDs are crucial for managing graft creep through precise tensioning and re-tensioning, preventing postoperative laxity.
• The ability of ALDs to achieve differential tensioning aids in restoring native knee kinematics and function.