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Introduction: Femoral graft fixation in the anterior cruciate ligament reconstruction is a key factor to the success of this procedure. The aim of this study is to compare two different femoral fixation methods in the anterior cruciate ligament reconstruction. Material and methods: 147 patients with an anterior cruciate ligament reconstruction with quadruple hamstring grafts were retrospectively analyzed. 16 were female and 131 male, average age was 26.3 years. The minimum follow-up was 12 months with an average of 62 months. Patients were divided into two groups according to the femoral graft fixation: in ninety eight patients a transverse fixation was used, and in forty nine a cortical fixation with femoral button. Tibial interference screws were used for both groups. Clinical evaluation with Lysholm Score and IKDC was performed. Results: Lysholm score results show no significant differences between the groups, being 94.24 points in the group with the transversal fixation system and 93.26 in the other group. According to the IKDC, 141 patients presented a normal or close to normal knee and 1 patient presented an abnormal knee. Five patients presented graft rupture (3.4%), 3 from the cortical fixation with button group (6.12%) and two with transverse fixation (2.04%). Conclusion: In this study, cortical button femoral fixation for autogenous hamstring ACL reconstruction had no significant difference in terms of clinical outcomes compared with suspensory transfemoral fixation.