Mechanical Properties of an Adjustable-Loop Cortical Suspension Device for Anterior Cruciate Ligament Reconstruction

BACKGROUND: Various biomechanical properties of adjustable-loop cortical suspension devices have been observed among previous studies in which different experimental conditions were used to test each of these devices. However, no studies have investigated the biomechanical properties of single adjustable-loop cortical suspension devices under different cyclic loading protocols. It is necessary to clarify the problems associated with using this device and detect the best method of using it in the clinical setting. HYPOTHESIS: The elongation of the loop of an adjustable-loop cortical suspension device with cyclic loading would be smaller with (1) an increase in the lower force limit and (2) lower speeds of cyclic loading. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen anterior cruciate ligament (ACL) adjustable-loop cortical suspension devices were tested under the following 3 cyclic loading protocols in a device-only model. Protocol A included cyclic loading between 10 and 50 N at 50 mm/min for 500 cycles. The upper force limit was then increased by 25-N increments every 500 cycles up to 250 N, for a total of 4500 cycles. Protocol B included cyclic loading between 30 and 50 N at 50 mm/min for 500 cycles. The upper force limit was then increased to 250 N, for a total of 4500 cycles, in the same manner as protocol A. Protocol C included cyclic loading between 30 and 50 N at 25 mm/min for 500 cycles. The upper force limit was then increased to 250 N, for a total of 4500 cycles, in the same manner as protocol A. RESULTS: The elongation after 4500 cycles was 36.1, 18.5, and 8.6 mm for protocols A, B, and C, respectively. There were significant differences among the 3 protocols, with protocol C showing the smallest elongation with cyclic loading. The elongation in each group progressed with each 25-N cyclic load increment. CONCLUSION: The adjustable-loop cortical suspension device showed a smaller elongation of the loop with increases in the lower force limit and with lower cyclic loading speeds. CLINICAL RELEVANCE: Care should be taken during rehabilitation after anatomic ACL reconstruction using adjustable-loop cortical suspension devices with a low initial tension at graft fixation. Slow and less intense exercises may be more desirable in the early stages of healing.