Button screw versus button staple anchor in single bundle anterior cruciate ligament reconstruction: A comparative study of gait analysis, outcome analysis and cost effectiveness

Anterior cruciate ligament injuries are common, particularly in young athletes. Reconstruction is preferred due to its higher long-term success rate. In Indonesia, the reconstruction is often limited to high-tier hospitals due to the cost constraints imposed by national insurance. The study was aimed to compare functional outcomes, gait analysis and cost between two methods of fixation: button screw and button staple anchor. This prospective cohort study was conducted at a single center in Indonesia. Twenty-five patients undergoing single-bundle anterior cruciate ligament reconstruction with either button screw (imported titanium and biodegradable polymer) or button staple anchor (domestic stainless steel 316L) fixation were included. Data w ere collected pre-operatively and at least seven months post-operatively. Functional (KOOS, LEFS and IKDC), clinical outcomes (Lachman test, Anterior drawer test and Laximetry), gait analysis (stride length, stride time, cadence, gait velocity, angular joint velocity, peak knee angle, vGRF and knee momentum force) and cost effectiveness analysis were evaluated. Significant improvements in functional outcomes were observed in both groups post-operatively (P < .05). However, there were no significant differences between groups in clinical and functional outcomes (P > .05). Notable differences in gait biomechanics were found: higher angular knee velocity (P = .018), vertical ground reaction forces (P = .019), and knee flexion moment (P = .022) in the button staple anchor group. Both methods provided equivalent clinical and functional outcomes, supporting optimal graft stability and healing. The button staple anchor demonstrated superior biomechanical performance and cost-efficiency, making it a promising option for broader anterior cruciate ligament reconstruction accessibility in resource-limited settings.