Endobutton Femoral Fixation for Hamstring Anterior Cruciate Ligament Reconstruction: Surgical Technique and Results

Abstract

Summary: The technique for endobutton femoral fixation of double semitendinosus/ double gracilis hamstring anterior cruciate ligament (ACL) reconstruction is described. Two- to 8-year follow up of 139 primary ACL reconstructions in skeletally mature patients found 86% IKDC normal stability and 97% 3 mm KT 1000 side-to-side stability rates. No knee had 5 mm or greater differences. There were no graft failures and no clinical knee instability. No endobutton lost position. There were no deep knee infections or hardware-related complications. Endobutton femoral fixation produced high levels of knee stability with no hardware-related complications. Key Words: ACL—Knee—Femoral fixation—Hamstring. In our metaanalysis of stability after anterior cruciate ligament (ACL) reconstruction, we found endobutton and interference screws to be the most commonly used femoral fixation devices among clinical series reported since 1990 that met our criteria for inclusion. The endobutton (Smith and Nephew, Andover, MA) is a cortical suspensory ACL fixation device. It is a 12-mm long oval button with a woven loop passed through its 2 central holes. A quadruple hamstring (HS), or any similar soft tissue, graft is passed through the loop and doubled back on itself. We began using it in 1993 and have used it continuously from then to the present. Its anchorage on cortical bone produces high stiffness, which is mitigated to a degree by the high length of the graft-fixation construct.10 Studies have shown it to have among the highest strength of any femoral fixation devices1 After a brief overview of the technique, we present clinical pearls that describe how to use the system to maximum advantage, how to avoid problems, and what to do if difficulties occur. We have found the system safe, reliable, and easy to use over a long period of time.