An endobutton is a fixation device to secure the upper end of a hamstrings graft during the procedure of cruciate ligament reconstruction.
Page updated June 2024 by Dr Sheila Strover (Clinical Editor)
![endobutton fixation](/assets/images/Community_Hub/noyes/endobutton04.gif)
The endobutton at the top is an example of 'suspensory' cortical fixation, where the device is on the outside of the bone and suspends the ligament, which would be fixed at the lower end with perhaps an interference screw.
![endobutton](/assets/images/Community_Hub/noyes/endobutton03.gif)
The endobutton can be manipulated by the 'strings' so that it can be turned longways to pull it through the tunnel, and then flipped sideways so that it cannot fall back into the tunnel once it is tensioned.
Rehabilitation after ACL hamstrings graft with endobutton fixation
Endobutton fixation allows full weight bearing ambulation with crutches immediately after ACL reconstruction surgery, provided there has been no concomitant meniscal repair procedures.
Gradual full range of motion with a brace may be allowed from the second week after surgery.
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Quote from peer-reviewed paper:
"...harvest of the hamstring tendon does not injure the extensor mechanism and produces less pain than harvest of the patellar tendon....[but] there is a certain elasticity in the graft-implant complex....resulting in graft-tunnel motion....[and] ....tunnel widening."
Citation: Kong CG, In Y, Kim GH, Ahn CY. Cross Pins versus Endobutton Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: Minimum 4-Year Follow-Up. Knee Surg Relat Res. 2012 Mar;24(1):34-9. doi: 10.5792/ksrr.2012.24.1.34. Epub 2012 Feb 28. PMID: 22570850; PMCID: PMC3341815.
Is an endobutton bioabsorbable?
An endobutton is not bioabsorbable. If it is causing problems it will have to be surgically removed.
Forum discussions
- My ACLr with a Quadriceps Tendon (QT) and Endobutton
A patient choose a quads graft for ACL reconstruction, together with endobutton fixation.
See also -
Slideshare -
ACL graft fixation options. Excellent Slideshare presentation by Associate Professor Dr Rajesh Purushothaman.