Autologous Cancellous Bone Interposition to Enhance Tendon‐Bone Integration in Hamstring Tendon Anterior Cruciate Ligament Reconstruction: A Surgical Technique

Abstract Hamstring tendon autografts remain a popular choice for anterior cruciate ligament reconstruction due to their favorable biomechanical properties and reduced donor‐site morbidity; however, delayed tendon‐to–bone integration and tunnel widening continue to limit outcomes when compared with bone–patellar tendon–bone grafts. Biological augmentation with autologous bone offers the potential to improve both the biological and mechanical environment at the graft‐tunnel interface. We describe a simple, reproducible, and cost‐effective surgical technique that utilizes cancellous bone harvested during tibial tunnel reaming to biologically and mechanically augment hamstring tendon anterior cruciate ligament reconstruction. Using a 10‐mL syringe sheath, bone reamings are collected, consolidated on the back table, and interposed within the graft and secured with circumferential 0‐Vicryl sutures. The graft is then sized, inserted, and fixed with a femoral EndoButton and tibial interference screw. This approach provides a biologically favorable and mechanically stable construct using autologous bone readily obtained during routine anterior cruciate ligament reconstruction. It offers a pragmatic means to promote tendon‐bone healing, enhance press‐fit fixation, and potentially reduce tunnel widening without additional graft harvest or biologic adjuncts.