Anatomic double-bundle anterior cruciate ligament reconstruction leaving hamstrings tibial insertion intact: technical note

This article describes an anatomic, double-bundle, arthroscopic anterior cruciate ligament reconstruction technique with hamstrings using second-generation out-in retrograde femoral drills, second-generation cortical femoral suspensory fixation devices with adjustable graft loop length, standard out-in tibial drills, and titanium low-profile tibial staples. Grafts choice is autologous gracilis and semitendinosus tendons. They are harvested through the single minimally invasive tibial incision maintaining their tibial insertion. Sutures are tightened at the free proximal tendon ends to obtain a sufficient strength to traction. The grafts are reflected in two separate loops and linked to femoral adjustable TightRope graft loops. With this method, grafts length can be customized to the anatomy of every knee and their tension can be increased even after graft fixation. The preservation of tendons tibial insertion could improve the neoligamentization process, acting as a tenodesis.