Comparison between functional outcomes of aperture fixation and suspensory fixation on the tibial side in arthroscopic anterior cruciate ligament reconstruction patients: A randomized control trial

Objectives: The objective was to compare the functional outcomes and pain trajectories associated with aperture (BIOSCREW) versus suspensory (T-BUTTON) tibial fixation in arthroscopic anterior cruciate ligament (ACL) reconstruction. Materials and Methods: A randomized controlled trial was conducted at a tertiary care hospital from June 2023 to February 2025. A total of 104 patients with isolated, complete ACL tears confirmed by magnetic resonance imaging were enrolled and randomized into two groups: BIOSCREW ( n = 52) and T-BUTTON ( n = 52). Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score, and pain was measured using the Visual Analog Scale (VAS) at multiple time points postoperatively. Results: A total of 104 patients were included in the study, with mean age comparable between the groups (BIOSCREW: 31.69 ± 9.99 years; T-BUTTON: 30.48 ± 9.79 years). The majority of patients demonstrated Grade 2 anterior drawer test results (BIOSCREW: 61.5%, T-BUTTON: 59.6%). Pre-operative VAS scores were similar (BIOSCREW: 4.02; T-BUTTON: 4.15). Post-operative pain was initially higher in the T-BUTTON group (5.21 vs. 4.85) but equalized by 3 weeks. IKDC scores improved similarly in both groups across all time points. Conclusion: Both BIOSCREW and T-BUTTON tibial fixation techniques yield comparable outcomes in pain management and functional recovery following arthroscopic ACL reconstruction.