Table 1.

Steps of Surgical Technique

Knee joint preparation

Use standard anterolateral and anteromedial knee arthroscopic portals.

Perform arthroscopic knee joint evaluation.

Assess and address concomitant lesions initially.

Perform hamstring tendon autograft harvesting.

Suture passage and lasso loop through ACL remnant

Using a curved arthroscopic rotator cuff hook for grabbing, pass a No. 2 white or co-braid ultrahigh-molecular-weight polyethylene fiber through the ACL remnant (from the AM portal), performing a lasso-loop configuration.

Retrieve the sutures through the AL portal.

Femoral and tibial tunnel preparation using EndoButton technique

Perform femoral tunnel preparation through the AM portal (cannulated aiming device with offset, 2.7-mm guidewire, 4.5-mm drill to produce first passing channel, final drill according to graft diameter, No. 2 Ethibond loop through tunnel).

Perform tibial tunnel preparation through the AM portal (ACL tibial drill guide set at 55°, 2.4-mm guidewire, final tunnel preparation according to graft diameter).

Graft passage and remnant securing on EndoButton device

Retrieve the sutures for the ACL remnant and the suture from the femoral tunnel through the tibial tunnel.

Pass the 2 free ends of the ACL remnant suture through each outside hole of the EndoButton device.

Using the No. 2 Ethibond, retrieve all sutures through the lateral femoral cortex.

Pass the graft, and secure it using an EndoButton at the femur and an interference screw at the tibia.

Remnant fixation and knot tying

Secure the No. 2 suture (passed from remnant with lasso-loop configuration) on the EndoButton device using non-sliding half-stitch locking knots.

For the post, use the suture end that does not form the lasso loop.

ACL, anterior cruciate ligament; AL, anterolateral; AM, anteromedial.