Biosteon Cross Pin Femoral Fixation and Tibial Interference Screw Fixation for Hamstring Anterior Cruciate Ligament Reconstruction

Advancements in surgical techniques for reconstruction of the anterior cruciate ligament (ACL) over the past decade have yielded increasingly favorable and reproducible outcomes. Numerous studies support the argument for hamstring tendon grafts as comparable in strength and stiffness to patellar tendon grafts. Most techniques now use fixation that maximizes initial strength and stiffness, and many also address the biologic factors involved in healing. These developments, along with the appeal of diminished harvest site morbidity associated with hamstring tendon grafts, have led to a sharp increase in the use of hamstring autografts. Femoral cross pin fixation for hamstring grafts has been shown to provide outstanding initial pullout strength, and this technique allows for a more anatomic femoral tunnel location, enhancing the biomechanical properties of the graft. The Biosteon femoral cross pin technique described in this article has the mechanical advantage of achieving "press-fit" graft fixation close to the knee joint and reproduces ACL anatomy by placing the graft in the native ACL footprint in the far posterolateral notch.