Four-Stranded Semitendinosus Tendon Anterior Cruciate Ligament Reconstruction With Mini-invasive Anterolateral Ligament Reconstruction

Anterior cruciate ligament reconstruction (ACLR) is presently acknowledged as a prevalent procedure within the field of sports medicine surgery. Among the various graft options available, autograft hamstring tendons have emerged as one of the frequently used choices. This selection is primarily driven by the advantages it offers, such as reduced postoperative knee pain and a comparatively smoother surgical recovery process, when compared with the use of bone–patellar tendon–bone autografts. Quadrupled (4-stranded) semitendinosus tendon grafts have gained substantial popularity in recent years. This graft option offers the advantage of preserving the gracilis tendon while simultaneously exhibiting exceptional biomechanical strength. Furthermore, clinical studies have shown that the combination of ACLR and anterolateral ligament reconstruction yields superior outcomes, circumventing the application of nonanatomic extra-articular procedures involving the use of the fascia lata. The objective of this technical note is to outline a meticulous approach for ACLR using a 4-stranded semitendinosus tendon graft, applying a double-suspensory fixation method, and incorporating a minimally invasive procedure for anterolateral ligament reconstruction.