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Dear Editor: We read with interest the article titled “FixedVersus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies,” which was published in the October 2018 issue of The Orthopaedic Journal of Sports Medicine. First, we congratulate the authors for publishing their study in this journal. Second, we would like to express some of our opinions on their article. We note some deficiencies in this study regarding the aspect of literature retrieval. In their review, the authors searched only 3 databases. The deadline for the literature search was November 20, 2017. So, why did this metaanalysis include a study published in 2018? If the authors searched unpublished studies such as gray literature, this should be further clarified. Another issue is that the review did not include all articles published before November 20, 2017. To the best of our knowledge, 2 articles were published before this deadline but were not included. As a supplement, we would like to provide additional information on these 2 articles as well as on 2 recent studies that were published in 2018. These studies were all eligible according to the authors’ inclusion criteria, and they are helpful in drawing a strong conclusion. Details of these 4 studies are shown in Table 1. One point worth noting from the Houck et al study is that the tested models were further divided into isolated device and specimen. However, in the later statistical analysis, these 2 completely different test models were combined for calculation. A better method of comparing the biomechanical differences between the fixed-loop and the adjustable-loop femoral cortical suspension devices is to make a strict distinction between the 2 test models when evaluating any of the indicators such as ultimate load and cyclic displacement.

orthopaedic journal of sports medicine

Systematic Review of Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: Letter to the Editor