Supplemental tibial fixation for anterior cruciate ligament reconstruction

This report describes transosseous backup suture fixation for anterior cruciate ligament (ACL) grafts of all varieties, used to distally augment proximal screw fixation in the tibia. Using a simple suture configuration, this method secures the ACL graft to the tibial cortex in conjunction with a proximal interference screw. The technique is applicable for all graft configurations, including allograft, autograft, bone, and both 2- and 4-strand soft-tissue grafts. The described technique is intended to be used for secondary or backup fixation of the graft in the tibial tunnel and not as primary fixation. This construct can be reproducibly created, making use of the sutures that are typically present on the graft after the interference screw is placed. This technique for backup tibial fixation precludes the need for external hardware, which in many instances may be symptomatically proud. Furthermore, use of this technique may represent a potential cost savings because no additional devices or equipment is used or purchased. This technique is simple, fast, and inexpensive, making use of available constructs to enhance the security of graft fixation during ACL reconstruction.