Anterior cruciate ligament reconstruction: graft fixation

Current fixation devices for anterior cruciate ligament reconstruction demonstrate broad differences in terms of initial mechanical construct properties and biological graft integration. Fixation techniques are classified as anatomical, non- or semi-anatomical, and direct or indirect. It is important to consider the influence of the varying factors of graft fixation not only on the mechanical stability but also on the biological healing and graft incorporation of anterior cruciate ligament reconstructions. Therefore, it was the purpose of this paper to discuss current anterior cruciate ligament reconstruction techniques and isolate the different factors of graft fixation and their relevance for mechanical stability and biological healing.