Hybrid Press-fit and Adjustable Button Femoral Fixation of Anterior Cruciate Ligament Semitendinosus and Bone-patellar Tendon-bone Autografts—A Technical Note

Abstract

Introduction: Many fixation methods are available for anterior cruciate ligament (ACL) grafts. Adjustable buttons (ABs) are characterized by their high fixation strength but have the disadvantage of potential stretching of their linking suture material. Press-fit bone plugs provide fixation at the joint line and enhance biological graft healing. Using both is thought to result in a higher fixation strength, enhancing graft biology and transferring the fixation point to the joint line. Materials and Methods: It is the aim of this technical note to describe a certain technique of ACL graft hybrid fixation for hamstrings or bone-tendon-bone grafts, using AB combined with bone grafting of the femoral and tibial tunnels with press-fit bone plugs or bone chips. Discussion: ABs are commonly used fixation devices for ACL grafts. AB also allows the surgeon to tighten the ACL graft in full or near full extension. The ultimate load to failure of AB has the potential disadvantage of rendering the ACL graft progressively slack. AB augmented with press-fitting bone plugs enhances biological potentials, adds to fixation strength, and transfers the fixation level of the graft from the outer femoral cortex to the joint line. Conclusion: Hybrid AB and bone plug fixation of ACL autografts, whether hamstrings or bone-tendon bone, optimizes ACL graft fixation by gaining advantages and omitting the disadvantages of both techniques.