Anterior Cruciate Ligament Reconstruction: Fixation Techniques

Area of Science:

• Orthopaedic sports medicine
• Biomechanical engineering

Background:

• Anterior cruciate ligament reconstruction (ACLR) is a common orthopaedic procedure with challenges in replicating native ACL function.
• Successful ACLR outcomes depend on understanding anatomy, biomechanics, graft selection, tunnel placement, tensioning, and fixation techniques.

Purpose of the Study:

• To review common graft fixation techniques used in anterior cruciate ligament reconstruction.
• To highlight the importance of secure graft fixation for successful clinical outcomes and early rehabilitation.

Main Methods:

• Review of common anterior cruciate ligament reconstruction graft fixation methods.
• Discussion of intratunnel fixation (interference screws), suspensory fixation, and supplemental techniques.
• Analysis of implant materials (metallic, PEEK, bioabsorbable) and fixation devices (suture-buttons, anchors, staples, screws/washers).

Main Results:

• Interference screw fixation may reduce graft-tunnel motion, widening, and creep.
• Suspensory fixation offers biomechanical strength but may be associated with increased graft-tunnel motion and tunnel widening.
• Supplemental fixation techniques address concerns about primary fixation adequacy.

Conclusions:

• Secure graft fixation is paramount in ACLR to prevent displacement, promote bone tunnel integration, and facilitate early rehabilitation.
• Orthopaedic sports medicine surgeons must be proficient in various fixation techniques for both primary and revision ACLR.