Glossary
Suspensory (button) fixation
Quick answer
Suspensory fixation holds a ligament graft by hanging it from a small metal button that sits on the outer surface of the bone, connected by a strong loop of suture through the tunnel. In Qatar, Dr. Pablo Gelber at Aman Hospital in Doha often uses it for ACL grafts.
What it is
The graft is looped over or stitched to a band of high-strength suture attached to a small oblong button, usually titanium, a little over a centimetre long. The button is pulled through the bone tunnel and flipped so that it rests flat on the outer bone, like a toggle bolt in a wall.
Some loops are adjustable, letting the surgeon tension the graft precisely and fill the tunnel with graft tissue.
Why it matters for patients
The graft sits snugly in the tunnel with its whole circumference in contact with bone, which supports healing. Buttons are small, lie under muscle, and are rarely felt.
Suspensory fixation is often combined with an interference screw at the other end of the graft. It is also used for PCL, MPFL and some meniscal root repairs.
Afterwards
The button is not removed routinely. Very occasionally it irritates the overlying tissue or is felt under the skin in slim patients, and can be taken out once the graft has healed. It is visible on X-rays, which helps the surgeon check its position.
Frequently asked questions
Can the button come loose?
Failure of a correctly seated button is uncommon. If it has not flipped properly at surgery, this is usually recognised and corrected during the operation or on early X-rays.
Will I feel the button on my thigh?
Most people do not feel it. In a few slim patients it can be felt as a small bump, which rarely needs any treatment.
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