Anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft has long been the gold standard in young athletes. Traditionally, aperture fixation using an interference screw is the most common method used to achieve femoral fixation. However, in recent years suspensory fixation utilizing an adjustable cortical button has gained prominence due to favorable healing and reduced iatrogenic injury during graft placement. However, little is known about the efficacy of suspensory fixation when using BPTB autograft.
To compare the effect of femoral-sided fixation methods (interference screw vs. cortical button) on patient-reported knee function and reinjury rate in young, active patients undergoing ACLR with BPTB autograft.
A retrospective study was conducted in patients undergoing primary ACLR with BPTB autograft using either interference screw or cortical button fixation. All patients completed the International Knee Documentation Committee Subjective Knee Evaluation (IKDC) and reported secondary ACL injury (if present) via an online survey. Demographic characteristics and patient-reported outcome measures were compared between groups using independent samples t-test. Distribution of patient sex and graft failure was compared between groups using chi-square tests. A-priori alpha level was p<0.05.
49 patients receiving cortical button and 24 patients receiving interference screw fixation were included in this analysis at an average of 30.4 months post-ACLR. Groups did not differ based on patient age (p= 0.15), sex (p= 0.56), nor body mass index (p= 0.47) (Table 1). There was no significant difference in IKDC score between groups (p= 0.73). There were 3 (6.1%) graft failures in the cortical button group and 2 (8.3%) in the interference screw group.
In patients undergoing ACLR with BPTB autograft, there were no significant differences between interference screw and cortical button fixation in the femur with respect to clinical outcomes or graft failure rates. This suggests that both methods are suitable for young, active patients.