Evaluation and comparison of clinical results of femoral ﬁxation devices in arthroscopic anterior cruciate ligament reconstruction Deniz Aydin a, ⁎, Mert Ozcan b,1 a Department of Orthopaedics and Traumatology, Near East University Faculty of Medicine, Nicosia, Cyprus b Department of Orthopaedics and Traumatology, Trakya University Faculty of Medicine, Edirne, Turkey abstract article info Article history: Received 18 December 2014 Received in revised form 23 March 2015 Accepted 15 April 2015 Available online xxxx Keywords: Anterior cruciate ligament Femoral ﬁxation Clinical results Arthroscopic reconstruction Background: Several femoral ﬁxation devices for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction are available but the best technique is unclear. Purpose: We hypothesized that different suspensory femoral ﬁxation techniques have no superiority to each other. The aim of this study is to evaluate and compare the clinical results of different suspensory femoral ﬁxation devices in arthroscopic ACL reconstruction. Study design: Level III, retrospective comparative study. Methods: 100 consecutive patients who underwent arthroscopic ACL reconstruction in a single institution with 40 months (12–67 months) mean follow-up time were divided into three groups according to femoral ﬁxation devices as ‘Endobutton’ (n:34), ‘Transﬁx’ (n:35) and ‘Aperﬁx’ (n:31). Length of painful period after surgery, time to return occupation and sporting activities, ﬁnal range of motion, anterior drawer and Lachman tests, knee instability symptoms, International Knee Documentation Committee subjective knee evaluation (IKDC) score, Short Form 36 (SF 36) score, Lysholm knee score and Tegner point of the patients were evaluated and com- pared between groups. Results: There were no signiﬁcant differences between the groups. All techniques resulted in signiﬁcant recovery in knee instability tests and symptoms. Conclusion: In this study, the clinical results of different suspensory femoral ﬁxation techniques were found to be similar. We believed that different femoral ﬁxation techniques have no effect on clinical results as long as the technique is correctly applied. Appropriate technique should be preferred according to surgeon's experience. © 2015 Elsevier B.V. All rights reserved. 1. Introduction Arthroscopic anatomical reconstruction is the current preferred sur- gical treatment method for anterior cruciate ligament (ACL) injuries [1]. Graft choice and graft ﬁxation methods are dependent on surgeon's preference [2]. Graft ﬁxation method is one of the most important is- sues. During early postoperative period, ﬁxation site of graft to the tun- nel is the weakest part of the reconstruction [3]. The strength of ﬁxation determines the rehabilitation protocol. The initial ﬁxation of graft must provide sufﬁcient strength and stiffness to avoid ﬁxation failure and restore stability of the knee for rehabilitation during the early postoper- ative period [3]. Femoral graft ﬁxation techniques with soft tissue grafts in arthroscopic ACL reconstruction were classiﬁed by Milano et al. as compression, expansion and suspension types [4]. Suspension type ﬁxation devices provide femoral ﬁxation of the graft with a femoral ﬁxation device remote from the intraarticular space. The graft is suspended over the femoral ﬁxation device as an indirect ﬁxation method. Suspension type ﬁxation devices were also divided into corti- cal, corticocancellous and cancellous ﬁxation methods. ‘Endobutton’ is cortical, ‘Transﬁx’ is corticocancellous and ‘Aperﬁx’ is cancellous sus- pensory femoral ﬁxation devices. Postoperative X-rays of ACL recon- struction with different femoral ﬁxation devices are given in Figs. 1–3. ‘Endobutton’ device is formed by a button with a continuous suture loop over it. A femoral tunnel from articular space to the cortex for the passage of the button and a femoral socket for the graft placement is prepared. The graft is loaded to the suture loop. The device with loaded graft is placed from the tunnels and the button is seated over the cortex with a ﬂip–ﬂap maneuver. ‘Transﬁx’ is a crosspin device providing transfemoral ﬁxation. After preparation of femoral socket, a ﬂexible wire is placed from lateral cortex to the medial cortex passing through the blind end of the femoral socket with the help of ‘Transﬁx’ guide sys- tem. The middle part of the ﬂexible wire is pulled out from the femoral socket through the tibial tunnel with the aid of guide system. The mid- dle part of the ﬂexible wire forms a loop outside. The graft is loaded to the loop. The ﬂexible wire is tensioned from both medial and lateral The Knee xxx (2015) xxx–xxx ⁎ Corresponding author at: Department of Orthopaedics and Traumatology, Near East University Faculty of Medicine, 99138, Nicosia, Cyprus. Tel: + 90 533 8260090; fax: +90 392 223 64 61. E-mail addresses: denizayd@yahoo.com (D. Aydin), mertozcan@trakya.edu.tr (M. Ozcan). 1 Tel.: +90 533 4144819. THEKNE-02073; No of Pages 6 http://dx.doi.org/10.1016/j.knee.2015.04.004 0968-0160/© 2015 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect The Knee Please cite this article as: Aydin D, Ozcan M, Evaluation and comparison of clinical results of femoral ﬁxation devices in arthroscopic anterior cruciate ligament reconstruction, Knee (2015), http://dx.doi.org/10.1016/j.knee.2015.04.004