1. The 8-Strand Hamstring Autograft in Anterior Cruciate Ligament Reconstruction 
Kunbo Park, M.D., Christopher M. Brusalis, B.A., Theodore J. Ganley, M.D. 
Arthroscopy Techniques 
Volume 5, Issue 5, Pages e1105-e1109 (October 2016)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
A graft preparation station facilitates preparation and tensioning of the 8-strand anterior cruciate ligament autograft construct.
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Each end of the graft preparation station is pictured in detail. (A) The femoral-side TightRope RT and the tibial-side TightRope ABS are seated in each tensioner attachment. (B) A suture is passed through the TightRope ABS loop (arrow), which is later used to pull the ABS through the tibial socket.
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
To clean the harvested semitendinosus and gracilis tendons for graft preparation, the muscle around the tendon is removed and the length of graft tissue is measured. To perform a transphyseal technique in patients with closing physes, the graft length used is between 26 and 28 cm to yield a graft length of 6.5 to 7 cm. To perform an all-epiphyseal technique in a pediatric patient with wide open physes, the total length of harvested tendon should be approximately 20 cm to yield a final graft length of 5 cm.
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
(A) After overlaying of the gracilis and semitendinosus tendons, they are loaded and looped in linkage with the TightRope ABS and marked 1.5 cm from the free end (arrow). (B) The 4-strand end is whipstitched together with No. 2 FiberLoop (arrow).
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
(A) The graft is folded through the TightRope RT (at the other end of the graft preparation station). The 4-strand end is secured back upstream and folded into the elbow of the graft formed at the TightRope ABS end (arrow). (B) In this case, the 8-strand graft length is 5 cm.
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
(A) Four suture places are marked on the graft: 2 on the tibial side (solid arrows) and 2 on the femoral side (open arrows). (B) By use of a total of 4 interrupted FiberWire sutures, each of these 4 stitches is passed through each of the 8 strands of tendon, and the suture free limb is wrapped once around the bundles, creating a self-reinforcing suture noose. (C) The final diameter of each side is determined for preparation of the bone tunnel. In this case, the thickness of the femoral side is 9.0 mm (solid arrow).
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

8. Fig 7
The GraftLink (Arthrex) technique is used in 8-strand anterior cruciate ligament autograft fixation. Devices for passing both ends of the 8-strand anterior cruciate ligament graft are seen traversing the cannula. The TightRope RT will be passed into the femoral socket, whereas the TightRope ABS will be passed into the tibial socket. A TightRope ABS Button is fastened to the TightRope ABS loop to secure the distal end of the graft at the proximal tibia.
Arthroscopy Techniques 2016 5, e1105-e1109DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions