Cross-pin femoral fixation: A new technique for hamstring anterior cruciate ligament reconstruction of the knee

A new method of femoral fixation for arthroscopic anterior cruciate ligament (ACL) reconstruction using semitendinosus and gracilis (ST/G) tendons is presented. Biomechanical evaluation of the method was performed with pullout tests using animal tissues simulating fixation of ST/G tendons passing around a 2.5-mm pin placed transversely through a femoral tunnel. Clinical assessment of 22 patients was performed according to IKDC, Tegner, Lysholm, isokinetic strength, and KT1000 standards. Fixation strengths ranged from 725 N to 1,600 N for yield and maximal loads to failure for 35-mm to 70-mm cross-pins. Clinical results at mean follow-up of 30 months showed one traumatic failure, IKDC 86% normal or nearly normal, Tegner 6 ave, Lysholm 93 ave, KT1000 86% < 3 mm side-to-side difference on maximal manual evaluation, and isokinetic strength testing of quadriceps 8% deficit with hamstrings 8% deficit. Cross-pin fixation of ST/G tendons may be one of the strongest modes of femoral graft attachment yet devised. Our clinical outcomes in this initial series compare well with previous reports of ACL reconstruction regardless of graft or technique.