Graft fixation in cruciate ligament reconstruction

Cruciate ligament reconstruction has progressed dramatically in the last 20 years. Anatomic placement of ligament substitutes has fostered rehabilitat ion efforts that stress immediate and full range of motion, immediate weigh tbearing, neuromuscular strength and coordination, and early return to athl etic competition (3 months). This has placed extreme importance on secure g raft fixation at the time of ligament reconstruction. Current ligament subs titutes require a bony or soft tissue component to be fixed within a bone t unnel or on the periosteum at a distance from the normal ligament attachmen t site. Fixation devices have progressed from metal to biodegradable and fr om far to near-normal native ligament attachment sites. Ideally, the biomec hanical properties of the entire graft construct would approach those of th e native ligament and facilitate biologic incorporation of the graft. Fixat ion should be done at the normal anatomic attachment site of the native lig ament (aperture fixation) and, over time, allow the biologic return of the histologic transition zone from ligament to fibrocartilage, to calcified fi brocartilage, to bone. The purpose of this article is to review current fix ation devices and techniques in cruciate ligament surgery.