{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T20:28:57Z","timestamp":1787689737640,"version":"build-2784847793"},"reference-count":49,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Shortcomings to tibial-side fixation have been reported as causes of failure after anterior cruciate ligament reconstruction. Adjustable-loop suspensory devices have become popular; however, no comparison with hybrid fixation (ie, interference screw and cortical button) exists to our knowledge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>The purpose of this study was to compare the biomechanical properties of adjustable loop devices (ALDs) in full-tunnel and closed-socket configurations in relation to hybrid fixation. We hypothesized that primary stability of fixation by a tibial ALD will not be inferior to hybrid fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Tibial fixation of a quadrupled tendon graft was biomechanically investigated in a porcine tibia\u2013bovine tendon model using 5 techniques (n = 6 specimens each). The tested constructs included hybrid fixation with a cortical fixation button and interference screw (group 1), single cortical fixation with the full-tunnel technique using an open-suture strand button (group 2) or an ALD (group 3), or closed-socket fixation using 2 different types of ALDs (groups 4 and 5). Each specimen was evaluated using a materials testing machine (1000 cycles from 50-250 N and pull to failure). Force at failure, cyclic displacement, stiffness, and ability to pretension the graft during insertion were compared among the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>No differences in ultimate load to failure were found between the ALD constructs (groups 3, 4, and 5) and hybrid fixation (group 1). Cyclic displacement was significantly higher in group 2 vs all other groups ( P &lt; .001); however, no difference was observed in groups 3, 4, and 5 as compared with group 1. The remaining tension on the construct after fixation was significantly higher in groups 3 and 4 vs groups 1, 2, and 5 ( P &lt; .02 for all comparisons), irrespective of whether a full-tunnel or closed-socket approach was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Tibial anterior cruciate ligament graft fixation with knotless ALDs achieved comparable results with hybrid fixation in the full-tunnel and closed-socket techniques. The retention of graft tension appears to be biomechanically more relevant than tunnel type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>The study findings emphasize the importance of the tension at which fixation is performed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671221096107","type":"journal-article","created":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T12:01:16Z","timestamp":1652270476000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Evaluation of Tibial Fixation Devices for Quadrupled Hamstring ACL Reconstruction"],"prefix":"10.1177","volume":"10","author":[{"given":"Elias","family":"Ammann","sequence":"first","affiliation":[{"name":"Balgrist University Hospital, Z\u00fcrich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Hecker","sequence":"additional","affiliation":[{"name":"Balgrist University Hospital, Z\u00fcrich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Balgrist University Hospital, Z\u00fcrich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jess G.","family":"Snedeker","sequence":"additional","affiliation":[{"name":"Balgrist University Hospital, Z\u00fcrich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro F.","family":"Fucentese","sequence":"additional","affiliation":[{"name":"Balgrist University Hospital, Z\u00fcrich, 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