Pros and cons of different ACL graft fixation devices

Graft fixation is an important component of success (or failure) of anterior cruciate ligament (ACL) reconstruction. Modern techniques, on the whole, are much stronger than first-generation techniques (such as suture over a post). This is significant as studies have demonstrated the importance of early rehabilitation to limit knee stiffness and prevent the deleterious effects of prolonged immobilization and/or limited weight-bearing for articular cartilage health and knee function. Thus, ACL fixation devices must provide strength and stiffness sufficient for rehabilitation and activities of daily living until biologic fixation has taken place. No ACL graft fixation device is perfect. The surgeon must weigh the pros and cons of the different ACL graft fixation devices before deciding which device to use for a particular patient.