title: Dimensional assessment of continuous loop cortical suspension devices and clinical implications for intraoperative button flipping and intratunnel graft length.
abstract: Continuous loop cortical suspension devices have been demonstrated to be more consistent and biomechanically superior compared to adjustable loop devices; however, continuous loop devices present unique challenges compared to adjustable loop devices, especially in short tunnel reconstruction applications. Specifically, adjustable loop devices have the advantage of a "one size fits all" approach, and the ability to tension these devices following button flipping allows for the intratunnel graft length to be maximized. Nevertheless, the reliability of continuous loop devices has sustained their widespread use. We hypothesized that continuous loop cortical suspension devices from different manufacturers would exhibit equivalent 15 mm loop lengths, as advertised. Loop length was measured using a tensile testing machine. Contrary to our hypothesis, continuous loop cortical suspension devices with equivalent advertised lengths exhibited different loop lengths (up to 27% discrepancy). Inconsistencies with regards to manufacturers' reported loop lengths for continuous loop devices could have serious clinical implications and additionally complicate technique transferal among devices. Consequently, the manufacturers' accurate and complete disclosure of the dimensions and specifications associated with each continuous loop device is critical. Furthermore, surgeon awareness of true loop length dimensions and inconsistencies among devices is needed to ensure optimal implantation and resultant clinical outcomes.
authors.affiliation: Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657.
authors.forename: Travis Lee
authors.initials: TL
authors.lastname: Turnbull
authors.affiliation: Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Smith
authors.affiliation: Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657.|The Steadman Clinic, Orthopaedic Surgery, 181 W. Meadow Drive, Suite 400, Vail, Colorado, 81657.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D001696:Biomechanical Phenomena; D004867:Equipment Design; D005269:Femur / Q000601:surgery; D006801:Humans; D008422:Materials Testing; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D015203:Reproducibility of Results; D013314:Stress, Mechanical; D013718:Tensile Strength; D019737:Transplants
keywords: ACL reconstruction; cortical button; flipping distance; ligament reconstruction; loop length