# Lower button‐cortex distance and lower revision rates with adjustable‐loop compared to fixed‐loop cortical suspension devices for anterior cruciate ligament reconstruction

## TL;DR

Adjustable-loop devices used in ACL surgery result in lower revision rates and better button positioning compared to fixed-loop devices.

## Contribution

Demonstrates that adjustable-loop cortical suspension devices improve surgical outcomes in ACL reconstruction.

## Key findings

- Adjustable-loop devices had a significantly shorter button distance from the lateral femoral condyle.
- Adjustable-loop devices were associated with significantly lower revision rates.
- No direct association was found between button distance and revision rates.

## Abstract

To compare button position following femoral fixation of an anterior cruciate ligament (ACL) graft using fixed‐loop cortical suspension device vs. an adjustable‐loop device. Subsequently, to assess the association of button position‐related factors and revision ACL reconstruction.

This was a retrospective cohort study of consecutive patients undergoing ACL reconstruction using fixed‐loop (Endobutton CL) and adjustable‐loop cortical suspension device (Ultrabutton) for femoral fixation in a single institution between 2009 and 2022. Demographic and operative characteristics were recorded. To assess soft tissue interposition the distance between the button and the lateral femoral condyle (LFC) was measured on X‐rays made on the first post‐operative day. Other measurements included button angle, relative position (anterior/middle/posterior), and button migration (assessed using most recent X‐rays).

Overall, 244 patients were included in the study. 59% of patients in the fixed‐loop group and 41% in the adjustable‐loop group. Hamstrings autograft was utilised most commonly (91%), while the rest of the procedures included allografts. A significantly shorter button distance from the LFC was noted in the post‐operative Antero‐posterior (AP) X‐ray of the adjustable‐loop button, 0.44 ± 0.52 mm versus 0.72 ± 0.84 mm, respectively (p = 0.002). Revision rates were significantly lower in the adjustable‐loop group (4%) versus the fixed‐loop group (12%, p = 0.035). No statistically significant direct association was found between button distance from the LFC and revision ACL reconstruction.

Adjustable‐loop cortical suspension devices for femoral fixation of an ACL reconstruction were associated with lower revision rates and a lower button‐LFC distance when compared to fixed‐loop devices.

Level III, retrospective comparative cohort study.