Citation, DOI, disclosures and article data
Citation:
Feger J, Murphy A, Cortical button. Reference article, Radiopaedia.org (Accessed on 13 Mar 2025) https://doi.org/10.53347/rID-88975
Cortical buttons, suspensory cortical buttons or suture 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, tendon or suture is attached to 1-6.
Like other implants, they come in different configurations, designs, sizes and materials 3-6. 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.
Plain radiograph
Cortical buttons are radiodense; they should be seated flat, snug fit to the cortex. Their position should be confirmed fluoroscopically after placement.
MRI
On MRI, they usually have a metallic appearance with a signal void in all sequences 7.
The radiological report should mention the following:
- position of the cortical button
- the integrity of the repair
- the bone tunnel
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1. Holt J, Preston G, Heindel K, Preston H, Hill G. Diagnosis and Management Strategies for Distal Biceps Rupture. Orthopedics. 2019;42(6):e492-501. doi:10.3928/01477447-20190723-05 - Pubmed
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2. Sutton K, Dodds S, Ahmad C, Sethi P. Surgical Treatment of Distal Biceps Rupture. American Academy of Orthopaedic Surgeon. 2010;18(3):139-48. doi:10.5435/00124635-201003000-00003 - Pubmed
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3. Bain G, Prem H, Heptinstall R, Verhellen R, Paix D. Repair of Distal Biceps Tendon Rupture: A New Technique Using the Endobutton. J Shoulder Elbow Surg. 2000;9(2):120-6. - Pubmed
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4. Lee S & Bedi A. Shoulder Acromioclavicular Joint Reconstruction Options and Outcomes. Curr Rev Musculoskelet Med. 2016;9(4):368-77. doi:10.1007/s12178-016-9361-8 - Pubmed
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5. Shafiq B & Thamyongkit S. Bimalleolar Ankle Fracture With Syndesmotic Sprain: ORIF and Suture-Endobutton Repair. J Orthop Trauma. 2019;33(4):S36-7. doi:10.1097/bot.0000000000001538 - Pubmed
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6. Porter D, Jaggers R, Barnes A, Rund A. Optimal Management of Ankle Syndesmosis Injuries. Open Access J Sports Med. 2014;5:173-82. doi:10.2147/OAJSM.S41564 - Pubmed
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7. Bouguennec N, Colombet P, Graveleau N, Jambou S. The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium After an Anterior Cruciate Ligament Reconstruction. Knee Surg Relat Res. 2019;31(2):132-6. doi:10.5792/ksrr.18.072 - Pubmed
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