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

The 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 (R), with more than 4 years of follow-up. Hypothesis: The 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 methods: One 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 (R) (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). Results: No complications related to the use of the EndoButton (R) 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 2mm. The mean value was 1.8mm (range, 0-11). Tibial tunnel enlargement was constant; diameter femoral tunnel enlargement was significant (> 2mm) in 27.6% of the knees. No femoral tunnel modification corresponding to the EndoButton (R) passage was observed. Discussion: The 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 (R) fixation make it a top-choice technique, like the corticocancellous graft procedures, but without their disadvantages. No secondary elongation attributable to the EndoButton CL (R) was observed. This femoral fixation procedure appeared necessary and sufficient to providing good mechanical stability for the graft in the femoral tunnel. Level of evidence: Level IV: retrospective therapeutic study. (C) 2009 Elsevier Masson SAS. All rights reserved.