title: Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.
abstract: OBJECTIVE
  the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft.
  
  
  METHODS
  thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes.
  
  
  RESULTS
  the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference.
  
  
  CONCLUSIONS
  the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Taketomi
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inui
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Yamagami
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Tahara
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Sanada
authors.affiliation: Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Hironari
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Nakagawa
keywords: EndoButton; anterior cruciate ligament reconstruction; bone-patellar tendon-bone; suspensory fixation