Arthroscopic remnant preservation anterior cruciate ligament reconstruction using quadrupled semitendinosus autograft with internal brace: A current technique

We present our arthroscopic technique for anterior cruciate ligament reconstruction (ACLR) using autogenous semitendinosus tendon graft with an internal brace (IB). Single-bundle ACLR with remnant preservation of the torn anterior cruciate ligament (ACL) stump and internal bracing is our preference to recreate the anatomic ACL, thereby providing anteroposterior stability in all patients with no considerable contraindications. We achieve suspensory fixation of the graft with an adjustable loop with a built-in IB consisting of a cortical button that anchors the proximal end of the graft to the femoral outer cortex. The tibial end of the graft with FiberWire sutures is anchored on the proximal tibia through an external attachable button system, onto which the IB is also tightened. The advantages of remnant preservation include accelerated graft revascularisation and remodeling, enhanced proprioception, reduced bone tunnel enlargement, and enhanced objective knee stability, and the IB protects the new ACL during rehabilitation, acting as a secondary stabilizer after the ligament is healed. Our technique helps to minimize the use of additional implants for anchoring IB and ensures cost-effectiveness.