[Current aspects of anchoring hamstring tendon transplants in cruciate ligament surgery]

The use of hamstring tendon grafts in cruciate ligament surgery has recently raised strong interest. Hamstring tendons are superior to the mid third patellar tendon graft by virtue of lower harvest site morbidity combined with high tensile strength. Osseous graft incorporation relies on a proper tendon-to-bone healing, which relies on specific biomechanical and biological boundary conditions. Several different fixation devices have recently been introduced, with special emphasis on high initial fixation strength and moving the level of fixation closer to the joint line, the so-called aperture fixation. The goal of the present review is to focus on the advantages and disadvantages of different fixation principles for hamstring tendon grafts in order to give a comprehensive insight into current developments, such as interference fit fixation, cross-pin fixation, and the concept of hybrid fixation.