A comparative analysis of cortical button and intratunnel fixation using interference screw for tibial fixation in anterior cruciate ligament reconstruction

Objectives: Anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts depends on secure tibial graft fixation to ensure stability and healing. The two main methods, cortical button and interference screw fixation, are widely used, but existing evidence on their clinical and radiological outcomes is still inconclusive. This study evaluates and compares the effectiveness of these two fixation techniques in arthroscopic ACL reconstruction. Materials and Methods: A prospective randomized controlled trial involved 80 patients aged 18–50 years with magnetic resonance imaging -confirmed ACL tears. They were randomly assigned to two groups: one with tibial fixation using a cortical button and the other with a bioabsorbable interference screw. All underwent arthroscopic ACL reconstruction with hamstring autografts and followed a standard rehab plan. Over 12 months, assessments included stability, range of motion (ROM), Lysholm Score, Tegner Scale, subjective and objective International Knee Documentation Committee (IKDC) scores, Knee Society Score (KSS), tibial tunnel diameter by computed tomography, and complications. Results: Both groups showed significant gains in knee stability, functional scores, activity levels, and ROM ( p < 0.05). After 12 months, 90% achieved Grade A objective IKDC scores. Minimal tibial tunnel widening occurred, with no significant differences in graft or fixation failure, infection, or revision surgery. Cortical button fixation yielded slightly better Lachman test results, but this did not improve overall clinical or radiological outcomes. Conclusion: Cortical button and interference screw tibial fixation yield comparable clinical, functional, and radiological outcomes after arthroscopic ACL reconstruction. Consequently, the choice of fixation method often depends on surgeon preference, implant availability, and cost rather than on differences in clinical effectiveness.