Cortical button

Last revised by Dr Joachim Feger on 08 Sep 2021

Cortical buttons or suspensory cortical buttons are surgical implants used in conjunction with sutures for the repair of ligament and/or tendon injuries, including biceps tendon rupture, pectoralis major injury, acromioclavicular injuries, syndesmotic injuries and anterior cruciate ligament injury

The buttons consist of a flat plate, usually with two or four holes where the suture is passed through, usually in a reciprocal fashion. The cortical button is deployed through a bone tunnel and tensioned at the opposite cortex of the bone to which the respective ligament or tendon is attached to 1-5.

Like other implants, they come in different configurations, designs, sizes and materials 3-5. They might be combined with other fixation devices like a tenodesis screw.

Cortical buttons are supposed to be fit tight against the opposite cortex of the structure they are supposed to attach.

Cortical buttons are radiodense; they should be seated flat, snug fit to the cortex. Their position should be confirmed fluoroscopically after placement.

On MRI, they usually have a metallic appearance with a signal void in all sequences 6.

The radiological report should mention the following:

  • position of the cortical button
  • the integrity of the repair
  • the bone tunnel

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Cases and figures

  • Case 1: distal biceps tendon repair
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  • Case 2: TightRope® syndesmotic repair
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  • Case 3: ACL reconstruction - femoral cortical button
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