Functional Outcome of Anterior Cruciate Ligament Reconstruction by Hamstring Tendon Autograft using Femoral Endobutton and Tibial Post Fixation

Open Access

Abstract

Background: ACL rupture is a common disabling injury in young, active people, leading to knee instability, delayed return to sport or work, and potential early osteoarthritis. Arthroscopic ACL reconstruction with hamstring autograft is widely used, and femoral EndoButton fixation is reliable, but optimal tibial fixation remains debated, particularly for maintaining early stability during rehabilitation. This study aimed to assess functional outcomes and early complications after hamstring autograft ACL reconstruction using femoral EndoButton and tibial post fixation. Methods & Materials: This prospective observational study was conducted at NITOR, Dhaka (2024–2025), enrolling consecutive skeletally mature patients with clinically unstable, MRI-confirmed ACL rupture undergoing arthroscopic hamstring autograft reconstruction with femoral EndoButton and tibial post fixation. Functional outcomes (IKDC, Lysholm) and activity level (Tegner) were recorded preoperatively and at 6 weeks, 3 months, and 6 months; stability, range of motion, and complications were documented, with late adverse events noted up to 12 months when available. Data were analyzed in SPSS v26 using descriptive statistics and paired or repeated-measures comparisons of score changes over time. Results: Among 40 patients (mean age 28.6 ± 6.9 years, 85% male), non-contact sports pivoting injury was the commonest mechanism (62.5%), and MRI showed complete ACL tear in 90% with frequent concomitant meniscal injury (57.5%) and chondral lesions (22.5%). Most reconstructions used a 4-strand semitendinosus ± gracilis graft (95%) with a mean diameter of 8.1 ± 0.6 mm, predominantly via transportal femoral tunneling (87.5%). Functional outcomes improved steadily, with IKDC increasing from 44.9 ± 11.7 preoperatively to 75.6 ± 9.1 at 6 months, and Lysholm from 52.6 ± 13.9 to 88.3 ± 8.6; Tegner rose from a median of 3 to 5. Postoperative course was uncomplicated in 72.5%, with minor numbness/dysesthesia (12.5%), superficial infection (5.0%), arthrofibrosis (5.0%), and suspected graft failure (2.5%), and no deep infections. Conclusion: Arthroscopic ACL reconstruction using a hamstring autograft with femoral EndoButton and tibial post fixation produced significant early improvements in IKDC, Lysholm, and Tegner scores, with low complication rates. These findings support the technique as a safe and effective option for restoring function in symptomatic ACL-deficient knees.