All-Suture Cortical Button Fixation in All-Inside Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft

The all-inside anterior cruciate ligament reconstruction technique has gained popularity because of its ability to preserve bone stock, accommodate shorter graft lengths, and reduce postoperative pain. Traditionally, this technique uses metallic cortical suspensory buttons for graft fixation, which are reliable but may cause soft-tissue irritation and hardware prominence. A recent modification to traditional all-inside suspensory fixation uses all-suture cortical buttons, eliminating the need for metallic or screw-based implants while maintaining secure fixation. This Technical Note describes an all-inside anterior cruciate ligament reconstruction technique that uses an all-soft tissue quadriceps tendon autograft, secured with only suture-based buttons (no metal, no plastic) on both the femoral and tibial sides.