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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Postoperative anteroposterior radiograph of a right Rt knee showing reduced EndoButton to lateral aspect of femoral cortex. Comparison between different femoral endobytton devices for ACL reconstruction with doubled hamstring tendon graft: In theory, this effect causes expansion and compression of the graft against the tunnel wall resulting in highest strength Milano et al.

Do adjustable loops lengthen? An unidentified pitfall of Endobutton use: Make an LF portal by longitudinally extending the guide pin incision.

The second aspect to be noted is the direction of bone tunnel axis during graft tension testing. Switch the shaver to a Vulcan probe to remove any interposed soft tissue beneath the EndoButton. The effect of cortical button location on its post-operative migration in anatomical double-bundle anterior cruciate ligament reconstruction.

The fixation procedure followed the same clinical protocol established for ACL reconstruction at femoral side of human knees. Reduce the migrated EndoButton to the proper position, and fit the EndoButton to the lateral cortex of the knee by pulling the graft on the tibial side. Results No fixation devices failed during the cyclic loading test. The fixation of graft is totally dependent of implant performance during this period.

Current surgical techniques do not allow adequate visualization of the button in its final position to confirm that it is correctly flipped over without soft-tissue interposition between the EndoButton and the iliotibial band ITB or vastus lateralis. The existence of different methods makes it difficult to compare results.


The arrow indicates the EndoButtons of the anteromedial and posterolateral graft.

ACL reconstruction suture button – ENDOBUTTON – Smith & Nephew

Comparison of fixation on the lateral cortex versus the anterior cortex. Other injuries, including osteochondral lesions and meniscal tears, enddobutton managed concomitantly depending on their severity. However, the Bio Cross-Pin performance was the best.

Please review our privacy policy. The Endobutton showed a yield point very close to the failure load when the endotape broke Figure 5. The anterior cruciate ligament ACL replacement with hamstring graft has been widely performed with positive results.

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

Caution is need when removing the soft tissue over the lateral aspect of the femoral cortex. Knee Surg Sports Traumatol Arthrosc. The femoral site becomes the weak point in this case. Previous studies have shown that the interference screws fixation on tibia is the weak point in ACL reconstruction when Bio Cross-Pin or EndoButton are used at femoral site Shen et al.

Over the top or endobutton for ACL reconstruction?

B Anteroposterior radiograph of a right Rt knee showing reduced position of endkbutton EndoButtons after arthroscopic reduction. A variety of testing parameters were used in these studies, including the use of femur-graft-tibia complex, the direction of pulling out the tendon, the rate of loading, and cyclic test protocol.

Three femoral fixation devices for anterior cruciate ligament reconstruction: There was no significant difference between Bio Cross-Pin failure loading: The first significant slippage of the graft occurs at this point. In the case in which the EndoButton migrates from the lateral aspect of the femoral cortex Fig 1 Aa lateral femoral LF portal is created through the femoral guide pin incision on the lateral aspect of the femur. A probe can be inserted through the same portal to help manipulate the EndoButton into the proper position at the lateral cortex of the femur by pulling the graft on the tibial side.


This factor makes the early postoperative period a critical time for successful surgery Becker et al. The principle of EndoButton is based on the cortical suspension of the graft. The force x displacement curves was used to calculate these variables because we are not focusing alc graft strain but the mechanical behavior of the whole system bone-graft-implant. Further research is needed to determine endboutton clinical relevance of these findings relating the ACL replacement at femoral side.

The yield loading displayed by both fixations was sufficient to support the loading applied during daily tasks and accelerated rehabilitation programs. Considering the energy that the femur-graft complex has absorbed up to the point of fixation failure, there was not differences between the both techniques evaluated.

Physical therapy, consisting of exercise without resistance, to improve range of motion is initiated immediately after surgery. Suture button—based femoral cortical suspension fixation of anterior cruciate ligament ACL grafts can facilitate a fast and secure graft fixation for ACL reconstruction.

Ultimate failure load N. The anchor point, however, is different. The laxity is related to loss of fixation by elongation of the graft, graft slippage, and plastic deformation of device.

The Cross-Pin is based on graft expansion. The slippage of the graft-fixation device interface was measured indirectly through the graft lengthening after 20,and load cycles. The mean displacement acll ultimate failure load and displacement at yield load for Bio Cross-Pin was significantly lower than EndoButton. Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction. This method allowed for harvesting of the soft tissue.