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The aim of this surgical Technical Note is to search for a way to prevent possible graft loosening in all-inside anterior cruciate ligament (ACL) reconstruction. We used a fixed-loop cortical suspensory device on the femoral end and a suspensory cortical fixation technique and sutures on the tibial end. Then we flexed the knee for 150 cycles, reexamined the tightness of the ACL graft, and compared it with the initial tightness. Loosening of the ACL graft, which is suggested to be related to suspensory cortical fixation, could be prevented using the button system on the femoral end and tightening the suspensory cortical fixation on the tibial end.

An Alternative Femoral Fixation in All-Inside Anterior Cruciate Ligament Reconstruction: A Solution for Preventing Possible Graft Loosening