2015 ISAKOS Biennial Congress ePoster #1291

Frequency of Failure in Fixation of Suspensory Fixation Devices for Femoral Fixation During Anterior Cruciate Ligament Reconstruction

Kenji Yoneda, MD, Osaka JAPAN
Tatsuo Mae, MD, PhD, Suita, Osaka JAPAN
Norimasa Nakamura, MD, PhD, Osaka, Osaka JAPAN
Norinao Matsumoto, MD, PhD, Osaka JAPAN
Yasukazu Yonetani, MD, PhD, Hirakata, Osaka JAPAN
Ken Nakata, MD, PhD, Suita, Osaka JAPAN

Moriguchi Keijinkai Hospital, Moriguchi-city, Osaka prefecture, JAPAN

FDA Status Cleared

Summary: The failure in fixing the button of TightRope occurred significantly more frequently during ACL reconstruction, compared to the button of Endobutton.




Suspensory fixation devices, including TightRope (TR, Arthrex), Toggle-Loc (TL, Biomet), and EndoButton-CL (EB, Smith+Nephew), are commonly used for femoral fixation during ACL reconstruction. Among them, TR and TL provide a technical advantage over EB in having an adjustable-length loop. But during femoral fixation, we often experience a failure in installing a button with an adjustable-length loop. The purpose of this study was to compare the frequency of failure in fixing the button between TR and EB.


54 patients with mean age of 28 (14-50) year underwent anatomic triple-bundle ACL reconstruction. They were randomly divided into two groups: TR group (25 patients; 11 males and 13 females) , EB group (29 patients; 13 males and 16 females). In ACL reconstruction, two femoral tunnels were created behind the resident’s ridge and just anterior to the cartilage margin, while three tibial tunnels were made in the footprint of each bundle. Two double-looped hamstring tendon grafts were prepared with TR or EB settled to the loop side. Then fixation devices with grafts were passed through the femoral and the tibial tunnels, and were flipped outside the femoral tunnels. Failure was defined when we failed to fix the devices on the femoral cortex in the first trial and tried to turn the button more than two times. Then the failure in fixing the button was recorded in anteromedial (AM) and posterolateral (PL) grafts in TR and EB groups, while comparing the frequency of failure between two groups in each graft. Statistical analyses were performed by use of the chi-square test. P-value less than 0.05 was regarded as statistically significant.


The failure in fixing the button in TR group was found for 8 patients (32%) in AM graft and 15 patients (60%) in PL graft. On the other hand, there was no failure in EB group. There was a significant difference in the frequency of failure between TR and EB groups in both AM and PL grafts.


The concept of TR is an easy fixation without flipping. Thus TR does not have any extra sutures for flip, which EB has. The button of EB could be turned outside of the femoral tunnel with pulling the extra suture, even though there were some soft tissues around the femoral tunnel. But the button of TR could easily fall back into the tunnel without fixation, when cleaning the soft tissue around the outside of femoral tunnel was insufficient. Therefore we have to pay minute attention to flip the button in case of using TR.


The failure in fixing the button of TR occurred significantly more frequently during ACL reconstruction, compared to the button of EB.