Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft and Modified Lemaire Extra-articular Tenodesis...

The addition of a lateral extra-articular procedure to anterior cruciate ligament reconstruction has been shown to improve rotational stability and reduce graft failure rates, particularly in high-risk patients. However, tunnel convergence remains a major concern in combined anterior cruciate ligament reconstruction and lateral extra-articular procedure techniques, as it may compromise graft integrity and lead to failure. This technical note describes a technique for anterior cruciate ligament reconstruction using a tripled semitendinosus graft, maintaining its tibial attachment, combined with a modified Lemaire extra-articular tenodesis. The femoral tunnel is created using an outside-in drilling technique, allowing both the intra-articular anterior cruciate ligament graft and the lateral extra-articular tenodesis graft to be secured within the same tunnel using a single interference screw. This approach simplifies the procedure by eliminating additional fixation devices and reducing the risk of tunnel convergence, while maintaining bone stock and cost-effectiveness.