Five randomized controlled trials with 317 patients were included in this systematic review and meta-analysis which assessed clinical and functional outcomes of anterior cruciate ligament (ACL) reconstruction using cortical button fixation and transfemoral suspensory fixation. Lysholm scores, clinical tests, and radiological tests were among the data collected. Results indicated no significant differences in clinical or functional outcomes between groups. The cortical button fixation group experienced significantly greater tunnel widening, although was not shown to have a clinical effect.