Soft-tissue graft fixation in anterior cruciate ligament reconstruction

Reconstruction of the anterior cruciate ligament (ACL) is performed frequently in the United States with predictably good results. Results are dependent on an early postoperative physical therapy program that stresses early motion. Early rehabilitation demands rigid intraoperative mechanical fixation of the graft allowing aggressive physical therapy to begin before biologic incorporation of the graft in the bone tunnels. Many patients and surgeons choose to use a soft-tissue graft, usually a hamstring autograft, for the reconstruction. Many fixation options exist today for fixation of this graft. The "best" fixation technique depends on several factors including graft choice and surgeon comfort. In this article, we review noninterference screw devices available for fixation of soft-tissue grafts in ACL surgery.