Primary Arthroscopic Repair of the Anterior Cruciate Ligament with Femoral Fixation Using an Adjustable EndoButton and Dynamic Reinforcement with High-Strength Suture.

Primary anterior cruciate ligament (ACL) repair has reemerged as an alternative in selected cases thanks to advances in arthroscopic techniques and the development of modern fixation devices. The present paper describes the arthroscopic ACL repair technique with femoral fixation using an adjustable EndoButton (Smith & Nephew) combined with dynamic reinforcement using a high-strength suture. This technique is primarily indicated for acute proximal ruptures (Sherman et al. types I and II), which present a good ligament remnant and healing potential. The procedure aims to preserve the original anatomy and proprioception, reduce the morbidity associated with graft harvesting, and maintain future reconstruction options. The technique involves suturing the ligament stump, using adjustable femoral fixation, and applying internal bracing to provide additional biomechanical stability. The proposed postoperative protocol, based on the rationale of stability, prioritizes early mobilization, progressive weight-bearing, and structured rehabilitation. This approach represents a promising alternative for carefully-selected patients, especially young athletes and skeletally-immature subjects, provided the indications and limitations of the technique are respected. Long-term studies are needed to consolidate the clinical efficacy of this technique.