Anterior Cruciate Ligament Reconstruction With Preservation of the Tibial Insertion of the Hamstring Tendons and Double‐Pulley Technique

Abstract Anterior cruciate ligament (ACL) injury is one of the most common knee disorders, occurring mostly in sports‐related injuries. After injury, knee stability is compromised, leading to further damage to surrounding structures, such as meniscal tears, cartilage wear, and other lesions. Therefore, timely and effective repair of the injured ACL is critical. At present, a variety of surgical techniques are available for ACL reconstruction, with substantial differences in graft selection and fixation methods, and no universal consensus has been reached in the academic community. Hamstring tendons are among the most commonly used autografts. Preservation of the tibial insertion of the hamstring tendons has been proven to provide distinct biological and mechanical advantages. This technical note introduces an ACL reconstruction technique using a double‐pulley system, which allows effective intraoperative adjustment of tension in each bundle of the reconstructed ACL to achieve highly uniform tension across all bundles. Furthermore, the native tibial insertions of the hamstring tendons (gracilis and semitendinosus) are preserved, maximizing blood supply to the reconstructed ligament. This approach facilitates the ligamentization of the graft and shortens the tendon‐bone healing period.