Pearls and Pitfalls of the ToggleLoc With ZipLoop for Anterior Cruciate Ligament Reconstruction

The ToggleLoc with ZipLoop is an adjustable suspensory device for anterior cruciate ligament reconstruction. However, there is no string to flip the button in the device because it has only one hole and one string. Therefore, the surgeon cannot use the button flip technique. The purpose of this article is to present the pearls and pitfalls of using ToggleLoc with ZipLoop. While preparing the ACL graft, we draw a 15- to 20-mm-width marking in the adjustable loop at the same length as the femoral tunnel depth. While passing of the graft, the tensioning sutures are placed at the anterior side to make sure they pass through the medial portal smoothly. The proximal passing suture and distal adjustable loop is pulled to the opposite direction by one surgeon's hands while passing the button. We stop pulling the sutures just at the marking while feeling the button being passed over the lateral femoral cortex. The distal artificial ligament is held distally with moderate tension while passing the graft. Although there are some pitfalls and knacks, the present technique is easy and certainly helps surgeons achieve appropriate positioning of the button.