Clinical and radiological outcome of Endobutton versus cross-pin femoral fixation in hamstring anterior cruciate ligament reconstruction

Background
The selection of a graft and the method of graft fixation are critical in anterior cruciate ligament (ACL) reconstruction surgery. ACL reconstruction with the hamstring tendon provides sufficient strength for early rehabilitation and activity; the tendon to bone healing and the fixation method can become an issue with the hamstring tendon, which affects the functional outcome.
Aim of the work
The aim of this study was to compare the clinical and radiological outcome of Endobutton femoral fixation and cross-pin femoral fixation for primary ACL reconstruction using quadrupled hamstring tendons with a minimum follow-up of 2 years.
Type of study
Retrospective study.
Patients and methods
Forty-five patients were evaluated 2 years after arthroscopic ACL reconstruction. Two methods of graft fixation were compared: in group 1 (20 patients, EB group), an indirect graft fixation was achieved utilizing the Endobutton with a manually knotted polyester tape for proximal femoral fixation combined with bicortical suture and post-tibial fixation. In group 2 (25 patients, TF group), a direct graft fixation was achieved utilizing cross-pin femoral fixation (TransFix II Pin) with an additional autograft bone plug inserted into the femoral tunnel. Tibial fixation of the graft was performed with a bioabsorbable interference screw and an additional staple on the graft. All cases were operated using a transtibial technique.
Results
According to the IKDC evaluation form, the clinical outcome of the TF group was better than that of the EB group. Radiographs of the EB group showed a higher degree of divergence of the osteosclerotic lines indicating the bone tunnels in comparison with the TF group. The entrance diameters of the drilled femoral bone tunnels were 12.5 and 10.5 mm in the EB group and the TF group, respectively ( < 0.05).
Conclusion
We conclude that avoiding tapes and sutures and using a surgical technique with direct graft fixation minimizes movement of the tendon graft for ACL reconstruction and improves the clinical results.