Secure graft fixation is critical during surgical reconstruction of cruciate ligament injuries to withstand physiologic loads during postoperative rehabilitation. This may be achieved through aperture, suspensory, post, or hybrid fixation techniques— each of which has certain advantages and disadvantages. Suspensory fixation uses an extracortical plug linked to the graft by sutures, with the point of fixation lying at the level of the external rim of the bone tunnel. It is associated with fewer instances of hardware-related complications than post fixation with cross-pins, and avoids the inevitable crushing of the graft observed following aperture fixation. Cortical suspensory fixation devices (CSFDs) are made of metal or poly-ether-ether-ketone. Fixed-loop CSFDs are associated with low cyclic displacement, but require long sockets and precise socket-length assessment, since they cannot be adjusted once implanted. Adjustable-loop CSFDs are associated with greater initial displacement, but reduce the graft length requirement and the socket length necessary to flip the button, and are compatible with stand-alone tibial-side fixation. While suspensory fixation through the more recent ‘all-inside’ technique has the potential advantages of bone preservation, clinical outcomes are comparable to the conventional ‘complete-tunnel’ technique. CSFDs may fail through breakage of the button or loop, or excessive elongation resulting in graft displacement. No consensus exists regarding the ideal CSFD for cruciate ligament reconstruction, and the choice of implant currently depends on the surgeon’s preference and the availability of specialized instruments.