Graft fixation is the mechanism by which a graft is attached to bone.

endobutton fixation
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.


Graft fixation in cruciate ligament surgery

Graft fixation is particularly relevant in cruciate ligament reconstruction - ACL and PCL - where the replacement graft has to be held in place during those weeks while the graft is being re-populated with blood vessels and fibrous tissue. Any device needs to be strong enough to avoid failure, stiff enough to restore knee stability and secure enough to avoid slippage.

Fixation may be -

  • Suspensory
  • Aperture


fixation device
graft fixation device


Anterior Laxity at 2 Years After Anterior Cruciate Ligament Reconstruction Is Comparable When Using Adjustable-Loop Suspensory Fixation and Interference Screw Fixation. Boutsiadis A, Panisset JC, Devitt BM, Mauris F, Barthelemy R, Barth J. Am J Sports Med. 2018 Aug;46(10):2366-2375. doi: 10.1177/0363546518784005. Epub 2018 Jul 17.

Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts. Persson A, Tone Gifstad T, Lind M, Engebretsen L, Fjeldsgaard K, Drogset JO, Forssblad M, Espehaug B, Kjellsen AB and Fevang JM. Acta Orthop. 2018 Apr; 89(2): 204–210.


ACL graft fixation options. Excellent Slideshare presentation by Associate Professor Dr Rajesh Purushothaman.

See also -

Suspensory Fixation


Aperture fixation Fixation