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Excellent bone plug–socket integration at 8 weeks after anterior cruciate ligament reconstruction using an adjustable-length loop cortical fixation device
  1. Ryohei Uchida1,2,
  2. Norimasa Nakamura3,
  3. Tomoyuki Suzuki4,
  4. Masashi Kusano2,
  5. Tatsuo Mae5,
  6. Kenji Ohzono2,
  7. Yukiyoshi Toritsuka2
  1. 1 Department of Orthopaedic Sports Medicine, Seifu Hospital, Sakai, Japan
  2. 2 Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan
  3. 3 Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
  4. 4 Department of Orthopaedics, Sapporo Medical University School of Medicine, Sapporo, Japan
  5. 5 Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
  1. Correspondence to Dr Ryohei Uchida, Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki Hyogo 660-0064, Japan; uchida3847{at}


Objectives Recently, adjustable-length loop cortical fixation devices (ALCFDs) have been developed. However, they are not frequently used for bone–patellar tendon–bone (BTB) grafting, mainly because it is uncertain whether an ALCFD enables sufficient integration of the bone plug. Thus, the purpose of this study was to evaluate bone plug–socket integration in anterior cruciate ligament reconstruction (ACL-R) with an ALCFD.

Methods Twenty consecutive patients with a mean age of 25±10 years underwent primary anatomic rectangular tunnel (ART) ACL-R with a BTB graft using BTB TightRope. The operated knees were evaluated by CT at 4 weeks and 8 weeks postoperatively. Union between the bone plug and the socket wall were assessed on 30 evaluation planes. No border between the plug and the socket wall, or trabecular continuity, were defined as complete union and a visible gap of >1 mm as incomplete union. When complete union was observed on >20, 11–20, 5–10 or <5 of the evaluation planes, bone integration was graded as excellent, good, fair or poor, respectively. In addition, the interface area between the plug and the socket wall was assessed by CT value index. Clinical evaluation was performed at 2 years postoperatively using the International Knee Documentation Committee (IKDC) form.

Results The proportion of patients with excellent bone integration was 20% at 4 weeks and 85% at 8 weeks, showing a significant difference (p=0.00015). Moreover, the CT value index of the interface area at 4 weeks was 25.8%±11.8% and that at 8 weeks was 15.3%±9.0%, again showing a significant difference (p=0.005). These suggest that bone integration of the interface area progresses over time and adequate at 8 weeks. Clinically, all 16 patients examined directly were rated their knees as normal or nearly normal with a mean side-to-side difference in anterior laxity at manual maximum force by KT-2000 of 0.2±0.3 mm.

Conclusion Excellent bone plug–socket integration was observed at 8 weeks after ART ACL-R using an ALCFD with satisfactory clinical results. An ALCFD could be safely applied for ART ACL-R.

Level of evidence 4 (case series).

  • knee
  • Ct-scan
  • acl / pcl
  • bone
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  • Patient consent for publication Not required.

  • Contributors Conceptualisation: RU and TS. Data curation: RU. Formal analysis: YT and NN. Investigation: RU and MK. Methodology: RU and TS. Project administration: YT, TM and NN. Resources: RU, MK and KO. Supervision: YT and NN. Validation: RU, YT and NN. Writing original draft: RU, YT and NN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Approval was obtained from the Kansai Rosai Hospital IRB prior to the start of this study (approval ID: 25–4).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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