Intraarticular EndoButton displacement in anatomic anterior cruciate ligament double-bundle reconstruction: A case report

Extra-anatomical fixation techniques are widely performed in anterior cruciate ligament (ACL) reconstruction. In particular, the EndoButton represents a popular device for femoral graft fixation not only in ACL single-bundle but also more recently in ACL double-bundle reconstruction techniques. Few technical pitfalls of the EndoButton technique have been reported in ACL single-bundle reconstruction. We present a case demonstrating an intraarticular EndoButton displacement of the posterolateral bundle at the metaphyseal cortex, which seems to be a specific complication in anatomic ACL double-bundle reconstruction. By addressing the anatomic femoral footprint of the posterolateral bundle, the exit of the femoral tunnel for the posterolateral bundle usually is located at the thinner metaphyseal cortex compared with the thicker diaphyseal cortex, which may represent a weak spot for the femoral graft fixation. In anatomic ACL double-bundle reconstruction, this metaphyseal location of the EndoButton may constitute a potential pitfall in restoration of the posterolateral bundle.