Recessed femoral interference screws in anterior cruciate ligament reconstruction

There are multiple modes of femoral fixation for the treatment of the anterior cruciate ligament (ACL)-deficient knee. Femoral interference screws are commonly used and are often buried to accommodate a graft-tunnel mismatch. After performing ACL reconstructions and imaging the ACL in 3 cadaveric knee specimens, obvious graft excursion and impingement was seen with recessed femoral interference screw fixation. The consequences of impingement are well known, and when faced with a graft-tunnel mismatch, alternative modes of fixation are advised.