Comparison of Long-Term Clinical and Radiologic Outcomes of Aperfix and Fixed Loop Device Fixation in Anterior Cruciate Ligament Reconstruction: a Retrospective Study

Abstract

Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups (P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used (P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups (P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.