Comparison of femoral tunnel widening after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral cross-pin fixation: a systematic review and meta-analysis

BACKGROUND: The aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation. METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to 11 April 2019. The study included all levels of evidence in studies that reported femoral tunnel widening and compared cortical button and cross-pin femoral fixation for ACLR. RESULTS: Six studies were included, covering a total of 344 knees. Using transtibial techniques for ACLR, the mean absolute amount of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross-pin fixation (−0.30 mm; 95% confidence interval (CI) −0.56,−0.05 mm; p= 0.02). Using the transtibial technique, the mean relative percentage of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross pin fixation (−5.73%; 95% CI −10.32, −1.14% ; p= 0.01). CONCLUSION: The present meta-analysis revealed greater widening of the femoral tunnel when using cortical button fixation for hamstring ACLR via the transtibial technique than when using transfemoral cross-pin fixation.