Editorial Commentary: Call for a Better Femoral Fixation Device in Anterior Cruciate Ligament Reconstruction: Adjustable-Loop Fixation Appears Better in Theory Than in Reality.

Abstract

Femoral tunnel widening after anterior cruciate ligament reconstruction is a major complication that results in more complex revision surgery. One prevailing theory of the source of this widening is the "bungee cord effect" resulting from suture fixation within the femoral tunnel. Adjustable-loop fixation devices were proposed to theoretically correct this by reducing the amount of suture within the femoral tunnel. Review of the current literature reveals mixed outcomes with most data pointing to no difference between the adjustable and fixed devices, especially with regard to tunnel widening. Adjustable-loop devices are not currently meeting the theoretical expectations, and the quest for improved femoral fixation continues.