There are an estimated , ACL repairs in the US each year: most ACL tears occurs from noncontact injuries. The % of the knee ligament injuries. Among femoral cortical suspension devices, the EndoButton CL . to confirm the position of the EndoButton after ACL reconstruction (Fig 3). One device used for femoral fixation of ACL grafts is the EndoButton Continuous Loop (Smith & Nephew. Endoscopy, Andover, Mass). This device has been well.

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The fixation procedure followed the same clinical protocol established for ACL reconstruction at femoral side of human knees. A 6 mm diameter bone tunnel was drilled in inside-out technique to the EndoButton fixation.

Author information Article notes Copyright and License information Disclaimer. The position of the EndoButton is confirmed with fluoroscopy after manual assessment to ensure that the button has been flipped.

Over the top or endobutton for ACL reconstruction?

Previous studies have shown that the biomechanical performance of the Bio Cross-Pin is superior that the EndoButton during cyclic and failure loading test Ahmad et al. The use of the autograft instead of an artificial graft was preferred to mimic the clinical practice of use a graft retrieved from the patient. The principle of EndoButton is based on the cortical suspension of the graft.

Therefore, the results do not warrant comparison to a clinical situation. The fixation device should promote stiffness near the native ACL to avoid an excessive graft motion and knee laxity until graft integration, To et al. The method used in our study did not represent the functional loading applied to the graft during flexion-extension movement Zhang et al. Postoperative Rehabilitation A standardized postoperative protocol is implemented for each patient.

The aim of this study was to evaluate the biomechanical performance of EndoButton and Bio Cross-Pin to fix the hamstring graft at femoral side of porcine knee joints and evaluate whether they are able to support of loading applied on graft during immediate post-operative tasks. Some surgeons have recommended the use of intraoperative fluoroscopy to assess the position of the button and its relation to the femoral cortex.


The slippage of the graft-fixation device interface was measured indirectly through accl graft lengthening after 20,and load cycles. The yield loading displayed by both fixations was sufficient to support the loading applied during daily tasks and accelerated rehabilitation programs. Immediately after the graft fixation, each femur was clamped to a custom device with bone cement PMMA and screws.

Confirm the migration of the EndoButton to the lateral cortex of the knee through the LF portal. As a result, the button pulled out from the cortical bone Ahmad et al. February 12, ; Accepted: We believe this arthroscopic reduction technique could be beneficial in the case of a migrated EndoButton during ACL reconstruction of the knee; however, endobutgon on long-term clinical outcomes with a larger cohort will be necessary to determine its efficacy.

ACL reconstruction suture button – ENDOBUTTON – Smith & Nephew

There is also a risk of damage to the EndoButton loop by using the Vulcan. A porcine model was used to compare the laxity, the strength, the linear stiffness and the energy associated with each technique. It is worth noting that some methods used in this experiment should be highlighted. Associated Data Supplementary Materials Video 1 After passage of the anterior cruciate ligament ACL graft through the tibial tunnel, the position of the EndoButton is confirmed by fluoroscopy after the EndoButton is felt to be flipped in a right knee.

This superior performance means that the Bio Cross-Pin is more secure to support the loads applied during aggressive rehabilitation protocol. They determined that migration of the EndoButton was more common with the presence of soft-tissue interposition and clinical outcomes were unaffected by migration and soft-tissue interposition. Yasuo OhnishiM.

The fixation of graft is totally dependent of implant performance during this period. Morrison reported N as the ACL force during normal level walking. Both are able to support the immediate post-operative loading applied N.

The results obtained indicate that both types of fixations analyzed in this study showed sufficient strength to resist the loads applied during functional activities in the early intensive rehabilitation. A 6 mm over-the-top guiding device was used to locate the anatomical ACL insertion.


If soft tissue is interposed between the EndoButton endobuttton lateral aspect of the femoral cortex, a radiofrequency RF probe Vulcan is inserted through another LF portal to remove the soft tissue. A fixed-loop cortical suspension device, the EndoButton CL, is used for femoral fixation.

When the failure did not occur in the Endotape, the displacement-load curve showed a different pattern.

Femoral fixation solution for ACL reconstruction | Smith & Nephew – Corporate

The Endobutton showed a yield point very close to the failure load when the endotape broke Figure 5. Femoral suspension devices for anterior cruciate ligament reconstruction: Discussion Studies in animal models have been widely realized to understand the biomechanical performance of several devices to fix the hamstring tendons in the femoral side in ACL reconstruction.

The results obtained in this experiment indicate that the Bio Cross-Pin technique promote stiffer fixation during cyclic loading as compared with EndoButton.

However, the interpretation of implant performance at femoral site testing the whole complex may be difficult since that the fixation on the tibia fail before that on femur fails Shen et al. Further research is needed to determine the clinical relevance of these findings relating the ACL replacement at femoral side.

Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: This measurement combined the effect of the fixation device slippage and tendon stretch.

The Wilcoxon rank sum test was used to compare the linear stiffness variable. Suture button—based femoral cortical suspension constructs of anterior cruciate ligament grafts can facilitate a fast and secure fixation.

Analysis of a semitendinosus autograft in a rabbit model.

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