# Loop technique for anterior cruciate ligament reconstruction combined with anterolateral structure reinforcement: technical description and clinical results

## TL;DR

This paper introduces a new surgical technique for ACL reconstruction combined with anterolateral reinforcement and shows improved knee stability and patient outcomes.

## Contribution

The novel Loop technique combines ACL reconstruction with anterolateral structure reinforcement for enhanced knee stability.

## Key findings

- Patients showed significant improvement in IKDC, Lysholm, and Tegner scores post-surgery.
- No significant increase in anterior tibial displacement was observed between operated and healthy knees.
- The Loop technique improved patient perception and restored knee stability in those with a high pivot shift.

## Abstract

We describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results.

The semitendinosus and gracilis tendons are braided into 5 strands and the ACL femoral tunnel and tibial tunnel are created. The graft is passed through the tunnel with the use of a traction suture and the tibial end is fixed with absorbable interference screws at 30° of knee flexion. The ACL graft traction suture is used as an anterolateral reconstruction structure to pass through the proximal exit of the ACL femoral tunnel and then through the depth of the iliotibial bundle to the anterior to Gerdy’s tubercle, a bony tunnel is created from the anterior to Gerdy’s tubercle to the goose foot, and the traction suture is passed through this bony tunnel to form a Loop structure at 20° of knee flexion. Between March 2021 and May 2022 IKDC score, Lysholm score, and Tegner score were performed preoperatively and 6–12 months postoperatively in 24 consecutive patients who met the indications for this procedure and underwent surgery. The patient’s maximum flexion angle, the circumference of the thigh, and the stress X-ray between the operated and healthy knee were measured.

Patients showed significant improvement in IKDC score, Lysholm score and Tegner score at a mean follow-up of 7 months postoperatively compared to preoperatively. No significant increase in anterior tibial displacement was found between the patient’s operated side and the healthy side.

The Loop technique ACLR combined with ALSA can be used in patients with an ACL tear combined with a high degree of positive pivot shift. The patient’s subjective perception was significantly improved from the preoperative period and knee stability was restored.

IV, therapeutic study.

The online version contains supplementary material available at 10.1186/s12893-024-02439-7.