Modified Universiti Kebangsaan Malaysia Internal Bracing Graft Preparation Technique Using Allograft for Anterior Cruciate Ligament Reconstruction Surgery

Anterior cruciate ligament reconstruction using allografts is limited by delayed biologic incorporation and graft elongation, increasing failure risks during early rehabilitation. To address this, we describe the modified Universiti Kebangsaan Malaysia internal bracing technique, which integrates ultra-high-molecular-weight polyethylene suture tape within the graft construct. This technique aims to provide immediate biomechanical reinforcement, reduce tunnel widening, and accelerate recovery, particularly critical for allografts, which lack the initial strength of autografts. The tendons are then quadrupled over tri-fold loops of FiberTape (Arthrex), which is centrally positioned and secured with FiberWire (Arthrex). The construct is whipstitched with 2.0 Ethibond (Ethicon)-while suture contact with the FiberTape is carefully avoided-and preloaded with an ACL TightRope II Implant (Arthrex) and TightRope Attachable Button System (Arthrex) for femoral and tibial fixation, respectively. Additional GraftLink loop graft construct (Arthrex) stitches are placed at both ends to enhance graft-tunnel integration. This technique uniquely embeds the FiberTape internally within the graft structure to provide biomechanical reinforcement while preventing tunnel abrasion and stress-shielding effects.