Comparing Outcomes of ACL Reconstruction with and Without Cyclic Graft Loading: A Two-Year Minimum Follow-Up Study

Background: The necessity of cyclic graft loading during anterior cruciate ligament (ACL) reconstruction remains debated. This study aimed to compare clinical outcomes between patients undergoing ACL reconstruction with and without cyclic graft loading. Methods: A retrospective comparative study was conducted involving 216 patients who underwent ACL reconstruction between 2021 and 2022. Patients were divided into two groups: those whose grafts were cyclically loaded intraoperatively (n = 104) and those who did not undergo cyclic loading (n = 112). All surgeries used hamstring autografts and similar fixation techniques. Outcomes, including graft re-rupture rates, knee laxity (measured by arthrometer, Rolimeter®), and patient-reported outcomes, were evaluated at a minimum follow-up of two years. Results: The demographics of both groups were comparable. Re-rupture rates were 2.5% in the cyclic loading group and 2.9% in the non-cyclic loading group (p = 0.78). Mean side-to-side laxity difference in anterior tibial translation measured by Rolimeter® was 1.1 mm ± 0.6 in the cyclic loading group and 1.2 mm ± 0.7 in the non-cyclic loading group (p = 0.39). No significant differences in Lysholm or IKDC scores were observed between groups. Conclusion: In this retrospective, non-randomized cohort, no statistically significant differences were detected between ACL reconstruction performed with or without cyclic graft loading. These findings should be interpreted with caution, given the potential for temporal confounding. Further prospective, randomized studies are required to confirm these results.