Femoral seating position of the EndoButton in single incision anterior cruciate ligament reconstruction: an anatomical study

Arthroscopic EndoButton fixation of anterior cruciate ligament (ACL) grafts over the femoral cortex has become popular in recent years. However, elongation of fixation materials has lead to tunnel enlargement, graft tunnel motion and instability. Synovial fluid passages along femoral tunnels following ACL reconstruction may result in destruction of tissues. The purpose of the present study was to identify the seating position of the EndoButton in regard to the boundaries of the knee capsule in single-incision arthroscopic ACL reconstruction. A total of 20 cadaveric knees were dissected and arthroscopic drill guides were used to create tibial and femoral tunnels. The distances between the exit points and boundaries of the suprapatellar bursa at three different degrees of knee flexion were measured. The average distances from the exit points to the superior boundaries of the suprapatellar bursa were 6.89 ± 5.40 mm (range, 16.87–1.21). However, in knee flexion of greater than 90°, tunnel exits were placed below the superior boundaries of the suprapatellar bursa (−7.08 ± 3.69 mm, range, −3.24 to −12.87). In order to place the EndoButton extraarticularly, a safe degree of knee flexion during femoral tunnel drilling was defined as 80°.