• Patrick A Smith, James P Stannard, Ferris M Pfeiffer, Keiichi Kuroki, Chantelle C Bozynski, and James L Cook.
• Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Columbia Orthopaedic Group, Columbia, Missouri, U.S.A.
• Arthroscopy. 2016 Jun 1; 32 (6): 1086-97.

PurposeTo compare all-inside cortical-button suspensory fixation in sockets versus interference screw fixation in tunnels with respect to clinical, histologic, and biomechanical assessments of all-soft tissue (AST) tendon autografts used for anterior cruciate ligament (ACL) reconstruction in a canine model.MethodsBy use of a validated "hybrid" double-bundle ACL reconstruction technique (reconstruction of the anteromedial bundle with preservation of the native posterolateral bundle), dogs were randomly assigned to undergo either suspensory fixation in sockets (n = 6) or interference screw fixation in tunnels (n = 6). Contralateral knees were used as nonoperated controls (n = 12). Quadrupled extensor tendon autografts were used for both ACL reconstruction groups. Dogs were assessed radiographically and functionally and humanely euthanized at 12 weeks after surgery for arthroscopic, gross, biomechanical, and histologic assessments.ResultsHistologic assessments showed significantly (P = .018) better graft incorporation with 4-zone direct healing to bone for the grafts using suspensory fixation in sockets (16.3 ± 1.5) compared with the grafts using interference screw fixation in tunnels (14.2 ± 2.1). Furthermore, graft healing to bone was significantly better at the aperture (P = .05) and mid-socket (P = .01) location for the group that underwent suspensory fixation in sockets (16.1 ± 1.8 and 16.4 ± 1.9, respectively).ConclusionsSuspensory fixation of AST grafts in sockets was associated with superior tendon-to-bone healing compared with interference screw fixation in tunnels, with 4-zone direct graft healing to bone seen for femoral and tibial sockets only in the suspensory-fixation group. Biomechanical properties were similar between groups.Clinical RelevanceThese data provide evidence suggesting that an all-inside ACL reconstruction technique using adjustable-loop cortical-button suspensory fixation in bone sockets has potential clinical advantages for ACL reconstruction using AST grafts.Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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