Comparison between Cortical Button versus Interference Screw Fixation for Anterior Cruciate Ligament Reconstruction using Quadrupled Hamstring Tendon Graft: A Clinical Performance Analysis

Background: Anterior cruciate ligament (ACL) reconstruction using hamstring autograft is currently the most prevalent option in treating ACL injury, however there are still difference in opinion in the current literature regarding the optimal femoral fixation method. Purpose: To compare knee stability and functional outcome scores at 12 months after ACL reconstruction using either cortical button or interference screw as a femoral fixation technique. Study design: Retrospective non-randomized comparative study. Method: 60 patients selected from January 2018-Decemeber 2019 that fulfilled the inclusion criteria, were retrospectively evaluated and distributed into two groups, according to the femoral fixation method in ACL reconstruction (cortical button, CB vs interference screw, IS). The primary outcome measure was knee stability measured with the anterior drawer test, Lachman test and pivot-shift test, and the secondary outcome measure was the functional outcome scores, as determined by the Tegner Activity Scale, Lysholm Knee Score, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score and Anterior Cruciate Ligament Return to Sports after Injury score, at 12 months post surgery. Result: Equal number of cases were selected for each treatment method (30 cortical button vs 30 interference screw). The knee stability measurements showed no difference between groups at 12 months of follow up, (P=1.000) for anterior drawer, Lachman and pivot-shift tests. Secondary clinical outcome measures also showed no statistical difference between groups at the end of the same follow up period, Tegner (P=0.19), Lysholm (P=0.23), IKDC (P=0.13), KOOS (P=0.34) and ACL RSI (P=0.12). Conclusion: Our results showed no significant difference in knee stability and clinical outcomes comparing cortical button versus interference screw in hamstring ACL reconstruction.