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Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis

PURPOSE: Button implants with either a fixed-loop device (FLD) or adjustable-loop device (ALD) are used frequently in Anterior Cruciate Ligament Reconstruction (ACLR). Since revision ACLR is associated with poorer clinical outcomes, it is important to investigate the difference in risk of revision b...

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Autores principales: Elmholt, Simone Birkebæk, Nielsen, Torsten Grønbech, Lind, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9587170/
https://www.ncbi.nlm.nih.gov/pubmed/36269424
http://dx.doi.org/10.1186/s40634-022-00544-1
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author Elmholt, Simone Birkebæk
Nielsen, Torsten Grønbech
Lind, Martin
author_facet Elmholt, Simone Birkebæk
Nielsen, Torsten Grønbech
Lind, Martin
author_sort Elmholt, Simone Birkebæk
collection PubMed
description PURPOSE: Button implants with either a fixed-loop device (FLD) or adjustable-loop device (ALD) are used frequently in Anterior Cruciate Ligament Reconstruction (ACLR). Since revision ACLR is associated with poorer clinical outcomes, it is important to investigate the difference in risk of revision between FLDs and ALDs. Therefore, this paper aims to systematically assess the risk of revision ACLR between ALDs and FLDs as well as secondary outcomes such as knee stability and patient reported outcomes (PROMs). METHODS: The online databases Embase, Medline (PubMed), and SPORTDiscus were searched, comparing FLDs and ALDs for femoral fixation in patients undergoing primary ACLR with hamstring autografts. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Due to heterogeneity a meta-analysis on revision rates were not possible. A random-effect meta-analysis was performed for the secondary outcomes and the quality of evidence was evaluated using the GRADE approach. RESULTS: Fifteen cohort studies with a total of 2686 patients were included. None of the studies found a clinical difference between ALDs and FLDs in either revision rates, knee stability or PROMS. However, the quality of evidence was graded “very low” due to study designs, risk of bias, and heterogeneity. CONCLUSION: Studies of better quality are needed to investigate the risk of revision ACLR between ALDs and FLDs. There was no difference in knee stability and PROMs between the ALDs and FLDs; however, the interpretation of these results is challenging due to low quality of evidence. LEVEL OF EVIDENCE: Level III.
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spelling pubmed-95871702022-10-23 Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis Elmholt, Simone Birkebæk Nielsen, Torsten Grønbech Lind, Martin J Exp Orthop Review Paper PURPOSE: Button implants with either a fixed-loop device (FLD) or adjustable-loop device (ALD) are used frequently in Anterior Cruciate Ligament Reconstruction (ACLR). Since revision ACLR is associated with poorer clinical outcomes, it is important to investigate the difference in risk of revision between FLDs and ALDs. Therefore, this paper aims to systematically assess the risk of revision ACLR between ALDs and FLDs as well as secondary outcomes such as knee stability and patient reported outcomes (PROMs). METHODS: The online databases Embase, Medline (PubMed), and SPORTDiscus were searched, comparing FLDs and ALDs for femoral fixation in patients undergoing primary ACLR with hamstring autografts. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Due to heterogeneity a meta-analysis on revision rates were not possible. A random-effect meta-analysis was performed for the secondary outcomes and the quality of evidence was evaluated using the GRADE approach. RESULTS: Fifteen cohort studies with a total of 2686 patients were included. None of the studies found a clinical difference between ALDs and FLDs in either revision rates, knee stability or PROMS. However, the quality of evidence was graded “very low” due to study designs, risk of bias, and heterogeneity. CONCLUSION: Studies of better quality are needed to investigate the risk of revision ACLR between ALDs and FLDs. There was no difference in knee stability and PROMs between the ALDs and FLDs; however, the interpretation of these results is challenging due to low quality of evidence. LEVEL OF EVIDENCE: Level III. Springer Berlin Heidelberg 2022-10-21 /pmc/articles/PMC9587170/ /pubmed/36269424 http://dx.doi.org/10.1186/s40634-022-00544-1 Text en © The Author(s) 2022, corrected publication 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review Paper
Elmholt, Simone Birkebæk
Nielsen, Torsten Grønbech
Lind, Martin
Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis
title Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis
title_full Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis
title_fullStr Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis
title_full_unstemmed Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis
title_short Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction – a systematic review and meta-analysis
title_sort fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in acl reconstruction – a systematic review and meta-analysis
topic Review Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9587170/
https://www.ncbi.nlm.nih.gov/pubmed/36269424
http://dx.doi.org/10.1186/s40634-022-00544-1
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