1. Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions 
Ravi Gupta, M.S., D.N.B., M.N.A.M.S., F.A.M.S., F.I.M.S.A., Raj Bahadur, M.S., F.A.M.S., F.R.C.S., F.I.M.S.A., Anubhav Malhotra, M.B.B.S., Gladson David Masih, M.Sc., Parmanand Gupta, M.S. 
Arthroscopy Techniques 
Volume 5, Issue 2, Pages e269-e274 (April 2016)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
With the tibial insertions of the tendons left intact, an open-ended tendon stripper is used to harvest the graft.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
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3. Fig 2
The femoral point of entry is marked with a bone awl at the junction of the lateral condylar ridge and bifurcate ridge with arthroscopic guidance.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
A guide pin is introduced into the femur, and with the knee in maximal hyperflexion, a 4.5-mm cannulated drill bit is used to create a tunnel in the femur.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4 The length of the tunnel is measured with a depth gauge.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
Length of femoral tunnel (length A) and length of tibial tunnel plus intra-articular part of graft (length B).
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
No. 5 Ethibond suture (left arrow) is passed into the tunnel, and the loop (right arrow) is parked inside the joint.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

8. Fig 7
By use of an anterior cruciate ligament tibial guide, the tibial tunnel is reamed.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

9. Fig 8
The Ethibond suture loop placed through the femoral tunnel into the joint is retrieved from the tibial tunnel with a grasper.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

10. Fig 9
The length of the tibial tunnel and the intra-articular part of the proposed anterior cruciate ligament graft is measured with a depth gauge.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

11. Fig 10
A marking suture (arrow) is placed on the hamstring tendons just opposite the entry of the tibial tunnel so that when the graft is pulled inside the joint, the mark stays at the entry of the tunnel.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

12. Fig 11
The length of the quadrupled graft and loop of the RetroButton is adjusted so that it exactly corresponds to length A (length of femoral tunnel) plus length B (length of tibial tunnel plus intra-articular part of graft).
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

13. Fig 12
The sutures of the RetroButton are pulled through the tibial and femoral tunnels by loading them onto the Ethibond loop placed in the tunnels.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

14. Fig 13
The free end of the graft exiting the tibial tunnel is pulled to maximal stretch and the joint moved through full range of motion at least 10 times to remove any kinks in the graft.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

15. Fig 14
With maximal stretch on the free end of the graft, it is sutured to the preserved end.
Arthroscopy Techniques 2016 5, e269-e274DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions