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Adjustable Versus Fixed Loop Devices and Revision Risk After Primary ACL Reconstruction With Hamstring Autograft
Andrew Fithian1, Heather A Prentice2, Chelsea E Reyes2
1Department of Orthopaedic Surgery, Gould Medical Group, Modesto, California, USA.
The American Journal of Sports Medicine
|October 23, 2025
Summary
Adjustable loop devices (ALDs) and fixed loop devices (FLDs) show no increased revision risk after hamstring anterior cruciate ligament reconstruction (ACLR) compared to interference screws. ALDs demonstrated a lower risk of ipsilateral reoperation than FLDs.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Sports medicine
Background:
- Adjustable loop devices (ALDs) are increasingly used for graft fixation in anterior cruciate ligament reconstruction (ACLR) due to their convenience and strength.
- Unlike fixed loop devices (FLDs), ALDs introduce a potential failure mechanism: loop lengthening.
Purpose of the Study:
- To compare the risk of revision and reoperation after ACLR using hamstring tendon autografts with ALDs versus other femoral fixation devices.
- To assess the association between ALD use and revision/reoperation rates.
Main Methods:
- A registry-based cohort study (Level of evidence, 3) analyzed data from 6910 primary isolated ACLRs using hamstring tendon autografts (2009-2022).
- Patients utilized either ALDs, FLDs, or interference screws for femoral fixation, with tibial fixation using interference screws.
- Cox proportional hazard regression models were employed to evaluate risks of aseptic revision, ipsilateral aseptic reoperation, and contralateral knee operation, adjusting for confounders.
Main Results:
- No significant differences in revision risk were found when comparing ALDs (HR, 1.11) or FLDs (HR, 1.16) to interference screws, nor when comparing ALDs directly to FLDs (HR, 0.96).
- No differences in ipsilateral reoperation risk were observed between ALDs/FLDs and interference screws.
- A lower risk of ipsilateral reoperation was noted for ALDs compared to FLDs (HR, 0.75; P = .027). ALDs (HR, 0.51) and FLDs (HR, 0.70) showed a lower risk of contralateral operation versus interference screws.
Conclusions:
- This study found no difference in revision risk for hamstring autograft ACLR using ALDs or FLDs compared to interference screws for femoral fixation.
- Adjustable loop devices (ALDs) were associated with a lower risk of ipsilateral reoperation compared to fixed loop devices (FLDs).
- These findings provide valuable data for surgeons selecting graft fixation methods in ACLR procedures.
