1. The 5-Strand Hamstring Graft in Anterior Cruciate Ligament Reconstruction 
Rushyuan Jay Lee, M.D., Theodore J. Ganley, M.D. 
Arthroscopy Techniques 
Volume 3, Issue 5, Pages e627-e631 (October 2014)
DOI: /j.eats
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
Graft preparation. (A) The folds and areas of whipstitching are marked out on the tendons. A 25.5-cm semitendinosus graft, marked out for a final folded construct length of 8 cm, is shown. The areas of whipstitching are highlighted in green, each 2 cm in length, except for at the third fold, where an additional 1.5 cm is whipstitched. (B) The longer of the 2 grafts, the semitendinosus, is marked out as depicted in A. The areas of whipstitching are highlighted with a marker, and the symbols indicate the planned folds (solid arrows indicate the first fold; asterisks indicate the second fold; open arrows indicate the third fold). The shorter of the 2 grafts is the gracilis, which is marked out to be doubled. (C) The grafts are whipstitched, and the extraneous graft has been trimmed. The arrows indicate the planned folds. © 2014. T. J. Ganley. All Rights Reserved.
Arthroscopy Techniques 2014 3, e627-e631DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Strands 1 and 2 of semitendinosus. (A) The semitendinosus graft is passed once through the loop of the cortical button, which itself has been secured to a post on the graft preparation board. (B) As the semitendinosus graft is pulled through the loop, it is folded at the first 8-cm mark (solid arrow). (C) The whipstitch in the midsubstance of the semitendinosus (asterisk) is pulled to tension the first and second strands equally. (D) The first and second strands are secured to a post, whereas the third strand remains free (open arrow). © 2014. T. J. Ganley. All Rights Reserved.
Arthroscopy Techniques 2014 3, e627-e631DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
Strand 3 of semitendinosus. (A) The semitendinosus graft is passed a second time through the loop of the cortical button and pulled through. (B) Once pulled through, the graft is folded a third time. The open arrow indicates the third fold. (C) The whipstitch at the third fold is tensioned, pulling the slack out of the third strand. (D-F) The tails of the whipstitch at the third fold are then secured back to the whipstitch upstream, where the whipstitch was first anchored. This suture is tied and then cut, completing the 3-strand semitendinosus. © T. J. Ganley. All Rights Reserved.
Arthroscopy Techniques 2014 3, e627-e631DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Gracilis preparation. (A) The shorter graft is passed through the loop of the cortical button and (B) tensioned individually. © T. J. Ganley. All Rights Reserved.
Arthroscopy Techniques 2014 3, e627-e631DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
Combined 5-strand construct. The free whipstitch sutures are tensioned individually for both the semitendinosus and gracilis, with a goal of equal tension in each strand. © 2014. T. J. Ganley. All Rights Reserved.
Arthroscopy Techniques 2014 3, e627-e631DOI: ( /j.eats )
Copyright © 2014 Arthroscopy Association of North America Terms and Conditions