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Purpose Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS). Methods A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects. Results Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes. Conclusion There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies. Level of evidence 1.

BackgroundOsteoid osteoma is a benign osteogenic tumor that occurs mostly in the femoral stem, while osteoid osteoma occurring in the lumbar vertebral body is a relatively rare case. To minimize treatment‐related complications, a computer‐assisted navigation fully visualized spinal endoscopy was used. Ultimately, the pathology was diagnosed as osteoid osteoma.Case PresentationWe report a 19‐year‐old adult male with low back pain that worsened at night and CT, MRI imaging showed an abnormal signal shadow at the posterior margin of the lumbar vertebral body. Due to the proximity of the lesion to the spinal canal and adjacent to the nerve roots, it was difficult to precisely localize the lesion by purely endoscopic or open procedures, and if necessary, the resection of surrounding tissues had to be expanded, causing unnecessary damage to the surrounding tissues. Therefore, we choose computer‐assisted navigation fully visualized spinal endoscopy to perform the treatment.ConclusionIn this case, we report an osteoid osteoma that occurs less frequently in the lumbar vertebral body. Using computer‐assisted navigation with fully visualized spinal endoscopy, we successfully resected the osteoid osteoma at the posterior margin of the L3 vertebral body preoperatively by computer‐planned path with intraoperative visualization endoscopy, minimizing the damage to spinal stability. Computer‐assisted navigation with visualization endoscopy provides a more precise and minimally invasive approach to the treatment of osteoid osteoma of the spine.