The TightRope attachable button system (ABS) has revolutionized minimally invasive, adjustable-loop suspensory fixation grafts used in knee ligament surgery. Suitable for all graft types, TightRope II ABS loops can be attached to a variety of button configurations for fixation over sockets created with a FlipCutter drill or full tunnels with concave buttons. During all-inside ACL reconstruction, use the TightRope II ABS implant for tibial fixation in QuadLink and GraftLink techniques or graft fixation over small bone tunnels created during transtibial ACL reconstruction.