"Cigar Wrap" technique for gracilis augmentation in hamstring anterior cruciate ligament reconstruction

The use of Hamstring grafts for anterior cruciate ligament reconstruction is becoming increasingly popular. Most surgeons use a four-stranded graft consisting of double-stranded semitendinosus and gracilis tendons. The gracilis tendon, in addition to being smaller in diameter, is often shorter and more diminutive at its muscular end. We developed a technique for supplementing this tendon using excess semitendinosus tendon. This allows enhanced tibial tunnel fit and improved graft fixation.