Large-Diameter Anterior Cruciate Ligament Reconstruction Technique With 8-Strand Semitendinosus and Gracilis Graft

Anterior cruciate ligament (ACL) reconstruction using a single 4-strand semitendinosus graft is a popular technique; unfortunately, the size (diameter) of the graft varies between 7 and 9 mm in many cases. The literature reveals that smaller diameter of the graft determines poorer Knee injury and Osteoarthritis Outcome Score sport/recreation functional scores and leads to revision surgery. Our Technical Note describes a method of preparing >10-mm size hamstring autografts in all cases while increasing the strength of fixation and covering as much of the anatomical ACL attachment footprint area as possible. We report an anatomic reconstruction technique of ACL with 8-strand semitendinosus and gracilis grafts fixed with 2 suspensory fixation systems-PULLUP (SBM, Lourdes, France). Combined with a complete tibial tunnel outside-in approach, this technique allows a quick and easy ACL reconstruction with a large diameter of the graft and increased stability of the fixation.