Analysis of Peroperative Lateral Femoral Cortical Burst Complication Related to ToggleLoc with ZipLoop in Anterior Cruciate Ligament Reconstruction

BACKGROUND/AIMS ToggleLoc adjustable loop suspension device is a widely used implant in anterior cruciate ligament (ACL) reconstruction, which offers several advantages. However, peroperative problems related to these devices are not clear. The objective of this study was to report and analyze the peroperalive lateral femoral cortical burst complication of ToggleLoc adjustable loop suspension device in ACL reconstruction. MATERIALS AND METHODS Fifty-two patients who underwent ACL reconstruction with ToggleLoc device were reviewed for peroperative lateral femoral cortical burst complication. The relation between lateral femoral cortical burst and tunnel position on lateral femoral cortex (condylar--epicondylor) was investigated from patients' records. A case-based analysis was done. Preoperative and postoperative Lysholm scores were also noted. RESULTS Peroperalive lateral femoral cortical burst complication was observed in four of 52 patients. In five of the 52 cases, ToggleLoc button was placed over the condylar region, and four of the cases with condylar button placement had the complication. The mean preoperative and postoperative Lysholm scores were 37.98 (min: 26, max: 62) and 91.73 (min: 81, max: 100), respectively. CONCLUSION ToggleLoc button structure and distal loading of tensioning sutures cause increased risk of lateral femoral cortical burst during ACL reconstruction. As a precaution, condylar placement of the femoral tunnel lateral cortical aperture should be avoided.