Anterior cruciate ligament reconstruction: Assessment of the hamstring autograft femoral fixation using the EndoButton CL®

SummaryThe objective of this study was to evaluate the clinical and radiological results of a prospective, continuous series of 105 ACL reconstructions using the STG tendons fixed to the femur by an EndoButton CL®, with more than 4 years of follow-up.HypothesisThe subjective and objective clinical results as well as the radiological results (tunnel enlargement) obtained by a cortical, extra-anatomic femoral fixation are at least equivalent to the results obtained with other types of femoral fixation systems.Material and methodsOne hundred and five patients aged with a mean 26 years (range, 12–56 years) were operated on for an anterior cruciate ligament rupture using the same technique and by the same operator: four-strand STG fixed to the tibia by a double fixation – BioRCI-HA screw and staple – and on the femur by an EndoButton CL® (Smith and Nephew). The results were assessed at 6 months, 1 and 2 years and then at a mean follow-up of 51 months, both clinically (IKDC, Lysholm, KT-1000) and radiologically (Telos laximetry, tunnel position, and morphological analysis).ResultsNo complications related to the use of the EndoButton® were observed. No additional interference screw was necessary. According to the IKDC laxity classification, 91.4% of the patients were classified in category A or B, nine knees (8.6%) were classified C or D. Four failures required revision with a patellar tendon graft. On the final IKDC score, 63 patients (60%) were classified grade A, 37 grade B (35.3%), four grade C (3.8%), and one grade D (0.9%). On the Telos laximetry, 62 patients (59%) had a differential laxity less than or equal to 2 mm. The mean value was 1.8 mm (range, 0–11). Tibial tunnel enlargement was constant; femoral tunnel enlargement was significant (> 2 mm) in 27.6% of the knees. No femoral tunnel diameter modification corresponding to the EndoButton® passage was observed.DiscussionThe results of this series are comparable to the results of other series. Its reproducibility and the absence of iatrogenic complications for this femoral EndoButton CL® fixation make it a top-choice technique, like the corticocancellous graft procedures, but without their disadvantages. No secondary elongation attributable to the EndoButton CL® was observed. This femoral fixation procedure appeared necessary and sufficient to providing good mechanical stability for the graft in the femoral tunnel.Level of evidenceLevel IV: retrospective therapeutic study.