Anatomic All-Inside Anterior Cruciate Ligament Reconstruction With a Modified Lemaire Extra-Articular Tenodesis:...

The past decade has seen changing trends in anterior cruciate ligament reconstruction surgery, with the hamstring becoming the most commonly used graft. Furthermore, the importance of extra-articular lateral tenodesis has been demonstrated to offer greater control of rotational laxity and a protective effect during cruciate ligament reconstruction. In this technical note, we describe a way to elaborate the graft with quadrupled semitendinosus tendon to obtain a compact and reliable graft. We provide tips and tricks to systematize and simplify the "all-inside" reconstruction technique and modified Lemaire's extra-articular tenodesis with femoral fixation in an independent bone tunnel under direct visualization to avoid confluence of the bone tunnels. This is a safe, reliable, and reproducible technique that causes less morbidity by removing a single hamstring tendon and preserving bone stock, with good clinical and functional results.