Table 2.

Indications, Contraindications, Tips and Pearls, Key Points, Complications, and Advantages of Technique

Indications

ACL torn from its femoral insertion

Good-quality ACL remnant

Contraindications

Chronic tears/atrophy of ACL remnant

ACL avulsed from its tibial insertion or midsubstance tears

Tips and pearls

In many acute tears, pass the lasso-loop stitch before ACL remnant dissection.

To easily grasp the suture with the rotator cuff hook that penetrates the remnant, bring the limb into a figure-of-4 position.

During suture retrieval from the tibial tunnel, first retrieve the lasso-loop sutures.

During the knot-tying step, bear in the mind that the knot pusher has to “penetrate” the iliotibial band and secure the non-sliding knots over the EndoButton device.

Key points

The end that does not form the lasso loop is used as the post.

Experience in arthroscopic shoulder knot-tying techniques is helpful.

Complications and pitfalls

Loose remnant fixation and possible cyclops lesion formation

Advantages

Preservation of all of the available remnant

No additional tunnel drilling

High-strength locking lasso-loop configuration

No longitudinal midsubstance remnant tearing during tensioning

Securing of remnant with the same fixation device

Easy suture retrieval through tunnels

Parallel course of graft and remnant sutures

Medial-portal ACL reconstruction

Tensioning of remnant—minimizing cyclops formation

No increased cost (1 additional suture)

Easy and reproducible

ACL, anterior cruciate ligament.