1. All-Inside Anterior Cruciate Ligament Reconstruction as a Salvage for Small or Attenuated Hamstring Grafts 
LCDR Patrick E. Jones, M.D., LCDR Dustin J. Schuett, D.O. 
Arthroscopy Techniques 
Volume 7, Issue 5, Pages e453-e457 (May 2018)
DOI: /j.eats
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2. Fig 1
Gracilis and semitendinosus tendons have been harvested; their doubled-over width is 7 mm. The ends of both tendons have been whipstitched.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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3. Fig 2
The longer of the 2 tendons is passed through the no-button tightrope and the stitched ends are passed in opposite directions through the femoral tightrope loop.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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4. Fig 3
The stitched ends are passed through the tibial side of the tendon on either side of the no-button tightrope using a free needle.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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5. Fig 4
The shorter tendon is wrapped around the quadrupled tendon and marked to the length of the quadrupled tendon, as shown with the blue arrow. The tendon is then cut and re-whipstitched at that level.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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6. Fig 5 The short tendon is placed inside the quadrupled tendon.
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7. Fig 6
The short tendon stitches are passed through the end of the quadrupled tendon on either side of the no-button tightrope and next to the stitches for the quadrupled tendon.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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8. Fig 7
The strands can be independently tensioned and the graft put on stretch.
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9. Fig 8
Using a No. 2 fiberwire or other high strength nonabsorbable suture, 4 circumferential cerclage stitches are placed around the graft starting inside the graft and making sure that the needle passes through every strand of the tendon.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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10. Fig 9
The completed graft has 4 cerclage stitches at 10 and 20 mm from either end of the graft. The shorter tendon is enshrouded in the quadrupled tendon providing a tight graft that should pass easily into the tunnels.
Arthroscopy Techniques 2018 7, e453-e457DOI: ( /j.eats )
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