Adjustable-Loop Devices Promote Graft Revascularization in the Femoral Tunnel After ACL Reconstruction: Comparison With Fixed-Loop Devices Using Magnetic Resonance Angiography

Abstract

Background: Hamstring tendon grafts are usually fixed in anterior cruciate ligament (ACL) reconstruction using either an adjustable-loop device (ALD) or a fixed-loop device (FLD). The contact area between the graft and the tunnel wall is different between the 2 devices. Purpose: To determine using magnetic resonance angiography (MRA) whether ALD and FLD result in different blood flow of the graft in the femoral tunnel during the early postoperative period. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2008 and 2018, a total of 42 patients (17 men and 25 women) underwent MRA at 3 months after ACL reconstruction. All surgical procedures were performed using semitendinosus tendon autografts folded into 4 strands. Overall, 23 patients underwent the FLD procedure and 19 patients underwent the ALD procedure. The signal intensity of the superior portion of the graft in the femoral tunnel was evaluated using transverse MRA images perpendicular to the femoral tunnel axis. Results: MRA images showed high signal intensity in the superior portion of the graft in the femoral tunnel in 94.7% and 60.9% of the ALD patients and FLD patients, respectively, a statistically significant difference ( P = .03). Conclusion: MRA images at 3 months after surgery revealed that blood flow reached the superior end of the tendon graft in the femoral tunnel in more patients who underwent ACL reconstruction with an ALD compared with an FLD.