Abstract
Graft fixation depends on surgeon preference, graft selection and surgical technique. For bone block fixation several studies have found interference screw fixation provides the most rigid fixation. However, in some instances such as posterior wall compromise and graft-tunnel length mismatch, rigid interference screw fixation may not be possible. While conversion to a two incision technique is an option, endoscopic approaches require alternative fixation methods. These include suture post, endobutton, and cross pin fixation on the femoral side and suture post or staple fixation on the tibial side. These fixation methods have weaker biomechanical properties and should only be employed when rigid interference screw fixation cannot be achieved. In addition, when these methods are employed, a less aggressive postoperative rehabilitation will be necessary until biologic incorporation is achieved.
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