Quadruple Semitendinosus Graft Construct and Suspensory Button Fixation for Anterior Cruciate Ligament Reconstruction

Surgical techniques for anterior cruciate ligament reconstruction are evolving, becoming less invasive, with fewer and smaller incisions, preservation of knee bone stock and tendons at the donor site, and better graft positioning and fixation. We describe an anterior cruciate ligament reconstruction technique that aims to preserve bone stock and spares the gracilis. The semitendinosus graft construct is prepared in a quadruple way and fixed with a cortical button in both tunnels, with increased stiffness and resistance of the graft construct. The tibial tunnel is filled at the end of the operation with a bone dowel, keeping the bone stock intact. This technique is safe, with a short learning curve; preserves the gracilis; saves bone; and increases the stiffness and resistance of the tibial fixation.