Posterior cruciate ligament (PCL) reconstruction is a surgical procedure used to restore posterior knee stability in selected patients with significant PCL insufficiency. One of the most important stages of the procedure is PCL graft fixation—securing the reconstruction graft within the prepared femoral and tibial tunnels or sockets.
Different fixation strategies can be used according to the surgical technique, graft type, tunnel configuration, bone quality and surgeon preference. Two important fixation technologies are interference screws and cortical button systems.
Within the ORTHOSYN arthroscopy portfolio, Interference Screws and Femoral Button Systems provide fixation technologies relevant to cruciate ligament reconstruction.
The posterior cruciate ligament is one of the major stabilizing ligaments of the knee.
Together with the anterior cruciate ligament (ACL), it contributes to controlling the relationship between the femur and tibia.
The PCL primarily helps resist excessive posterior translation of the tibia relative to the femur.
PCL injuries may occur as a result of:
Treatment depends on the severity of the injury, associated ligament damage, patient activity level and degree of instability.
In PCL reconstruction, a tendon graft is used to reproduce the function of the damaged posterior cruciate ligament.
Depending on the selected technique, the procedure generally involves preparing bone tunnels or sockets in the femur and tibia and positioning the graft to reproduce the anatomical course of the PCL.
A simplified reconstruction pathway can be described as:
Graft Preparation → Femoral/Tibial Tunnel Preparation → Graft Passage → Graft Tensioning → Graft Fixation
Fixation is particularly important because the graft must remain securely positioned while biological integration develops.
Immediately after reconstruction, the graft does not yet have biological integration with the surrounding bone.
The fixation system therefore provides the initial mechanical stability needed to maintain the graft in the intended position.
The general principle is:
Bone → Fixation Device → Graft → Reconstruction Construct
Fixation should support the selected graft tension and position while healing progresses.
Several factors influence the fixation strategy:
PCL graft fixation can involve different methods on the femoral and tibial sides.
Two important concepts are:
Aperture fixation — fixation is created close to the opening of the bone tunnel, commonly using an interference screw.
Suspensory cortical fixation — the graft construct is supported by a button positioned against the cortical surface of the bone.
These approaches use different mechanical principles and can be selected according to the reconstruction technique.
An interference screw is positioned between the graft and the wall of the prepared bone tunnel.
As the screw is inserted, it compresses the graft against the tunnel wall.
The concept can be represented as:
Bone Tunnel → Graft + Interference Screw → Graft Compression
This provides fixation close to the tunnel aperture and is widely associated with cruciate ligament reconstruction techniques.
Interference screws can be manufactured from different materials, including titanium, PEEK and bioabsorbable materials.
ORTHOSYN offers different interference screw technologies within its ACL/PCL fixation portfolio.
Interference screw fixation provides direct graft-to-tunnel fixation.
The screw occupies the space between the graft and bone tunnel, generating compression that helps secure the graft.
Potential considerations when selecting an interference screw include:
The dimensions of the screw therefore need to correspond to the specific reconstruction configuration.
Titanium interference screws provide a rigid metallic fixation option.
Titanium has a long history of use in orthopedic implants and provides a mechanically rigid implant structure.
In cruciate ligament reconstruction, the screw is inserted alongside the graft within the prepared tunnel to create interference fixation.
The basic concept remains:
Tunnel Wall → Titanium Screw → Graft Compression
PEEK (polyether ether ketone) provides a non-metallic alternative for interference screw fixation.
PEEK interference screws maintain a rigid implant structure while providing a different material option from metallic screws.
Characteristics associated with PEEK include:
Within the ORTHOSYN portfolio, PEEK interference screws form part of the broader cruciate ligament fixation range.
Bioabsorbable interference screws provide another material approach to graft fixation.
ORTHOSYN's broader cruciate ligament portfolio includes I-Bone bioabsorbable interference screw technologies, including material configurations such as PLDLLA + TCP.
These implants provide an alternative to permanent metallic or PEEK interference screw concepts.
Material selection should be based on the specific procedure, product indication and surgeon preference.
A femoral button system uses a different fixation principle from an interference screw.
Instead of compressing the graft directly against the tunnel wall with a screw, a cortical button provides suspensory fixation against the outer cortical surface of the femur.
A simplified concept is:
Graft → Suture/Loop Construct → Femoral Tunnel → Cortical Button
After passage through the femoral tunnel, the button is positioned against the cortical bone, creating a suspensory fixation point.
The major difference is the location and mechanism of fixation.
| Feature | Interference Screw | Femoral Button System |
|---|---|---|
| Fixation concept | Aperture fixation | Suspensory fixation |
| Primary mechanism | Graft compression in tunnel | Cortical suspension |
| Fixation device | Screw | Cortical button + loop/suture |
| Position | Within bone tunnel | Cortical surface |
| ORTHOSYN category | Interference Screws | Femoral Lift/Button Systems |
These technologies should therefore be understood as different graft fixation concepts, rather than interchangeable versions of the same implant.
Femoral cortical button systems can be incorporated into selected PCL reconstruction techniques to provide suspensory femoral fixation.
The graft construct is connected to the button through a loop or high-strength suture system. Once the button passes through the prepared femoral tunnel, it is positioned against the cortical surface.
The fixation pathway becomes:
PCL Graft → Adjustable/Fixed Loop → Femoral Button → Femoral Cortex
Depending on the system, the loop may provide adjustment that assists with graft positioning and tensioning.
Within the ORTHOSYN arthroscopy portfolio, Femoral Lift Systems provide cortical button technology for cruciate ligament fixation.
ORTHOSYN includes different button configurations, including adjustable systems designed to support graft positioning and fixation.
These systems provide a suspensory fixation concept that complements the ORTHOSYN interference screw portfolio.
This creates two important fixation categories:
ORTHOSYN Interference Screws → Tunnel/aperture fixation
ORTHOSYN Femoral Button Systems → Cortical suspensory fixation
The appropriate configuration depends on the selected reconstruction technique and the product's intended use.
Cruciate ligament reconstruction does not necessarily require identical fixation technology on both sides of the graft.
Depending on the technique, a surgeon may use different fixation principles on the femoral and tibial sides.
For example, a reconstruction strategy may incorporate:
Femoral Side → Cortical Button Fixation
Tibial Side → Interference Screw Fixation
The exact configuration depends on the graft, tunnel technique, fixation requirements and surgeon preference.
This is one reason a comprehensive ACL/PCL fixation portfolio can include both button systems and interference screws.
Graft tension is an important consideration during PCL reconstruction.
The surgeon must position and tension the graft according to the selected surgical technique before final fixation.
PCL reconstruction presents specific biomechanical considerations because the reconstructed ligament is intended to control posterior tibial translation.
Fixation technology therefore works as part of a larger surgical construct involving:
Tunnel Position → Graft Passage → Graft Tension → Fixation → Final Stability Assessment
The implant alone does not determine the result of the reconstruction.
PCL reconstruction techniques can also differ according to whether a single-bundle or double-bundle reconstruction is performed.
The native PCL is commonly described in terms of functional bundles, particularly the anterolateral and posteromedial bundles.
A single-bundle reconstruction typically reconstructs one principal functional component, while a double-bundle technique uses separate graft components and fixation points.
This difference can influence:
Consequently, graft fixation should always be considered within the context of the complete reconstruction technique.
PCL injuries occur in both athletic and traumatic settings.
Athletes involved in contact sports or activities associated with high-energy knee trauma may experience isolated PCL injuries or injuries involving multiple ligaments.
This creates an important informational pathway:
Knee Injury → PCL Tear → Knee Instability → PCL Reconstruction → PCL Graft Fixation → Interference Screw / Femoral Button
For ORTHOSYN, educational content about PCL reconstruction connects procedure-focused searches with the company's broader ACL/PCL fixation portfolio.
The ORTHOSYN arthroscopy portfolio includes multiple technologies relevant to cruciate ligament graft fixation.
Interference screw technologies provide graft fixation within the prepared bone tunnel. The portfolio includes different implant material concepts, including Titanium, PEEK and bioabsorbable options.
Femoral button technologies provide a cortical suspensory fixation concept and include systems designed for graft positioning and fixation during cruciate ligament reconstruction.
Together, these technologies allow ORTHOSYN to address two important principles of graft fixation:
Aperture Fixation + Suspensory Fixation
Product selection, size and configuration should always follow the selected surgical technique, patient anatomy and the specific product indications and instructions for use.
PCL graft fixation is a critical stage of posterior cruciate ligament reconstruction because the graft requires mechanical fixation while biological integration develops.
Two important fixation concepts are interference screw fixation and cortical button fixation.
Interference screws secure the graft within the bone tunnel through direct interference and compression, while femoral button systems provide suspensory fixation against the cortical surface.
Within the ORTHOSYN ACL/PCL portfolio, Interference Screws and Femoral Button Systems provide complementary fixation technologies for cruciate ligament reconstruction.
This creates a strong connection between ORTHOSYN fixation products and procedure-focused searches involving PCL reconstruction, PCL graft fixation, interference screws, femoral cortical buttons and knee ligament surgery.
