. 2019 Nov 11;8(12):e1437–e1441. doi: 10.1016/j.eats.2019.07.022

Table 1.

Step-by-Step Process

Steps
1. Patient positioning I. After anesthesia induction, bilateral stability and range of motion is assess. II. Place a well-padded high-thigh nonsterile tourniquet. III. Shift the patient closer to the leg post to produce a proper valgus when needed. IV. After sterile drape, an assistant should drop the end of the bed allowing a 90° flexion. 2. Diagnostic arthroscopy I. Through the standard portals (anteromedial and anterolateral), pay special attention to the integrity of the other ligaments, the femoral notch width and the presence of associated injuries. 3. Graft harvest I. With the patient's knee flexed 90°, perform a 3-cm long incision over the pes anserinus. II. To protect the medial collateral ligament, elevate the sartorial fascia from proximal to distal with a blunt object. III. Longitudinally incise the sartorial fascia and expose the gracilis and semitendinous tendons. IV. Release the deep portion of the sartorial fascia with a blunt right-angle clamp. V. Whip stitch the ends of both tendons. VI. With a striper harvest the tendons from distal to proximal. 4. Graft preparation I. Remove muscle fibers and unstable portions from the grafts. II. Measure the length of each tendon to plan the correct graft configuration. III. Simulate the graft configuration to determine the appropriate length and diameter. 5. Bone marrow cell harvest I. Insert a 14-gauge trocar through the anteromedial portal. II. Introduce the trocar 30 mm deep into the femoral notch apex. III. Turn off the arthroscopic fluid. IV. Remove the sty1et. V. Discard the first milliliter of blood. VI. With a 30-mL syringe preloaded with a heparinized solution slowly aspirate 60 mL of bone marrow. 6. Biological augmentation I. Under direct arthroscopic vision through the anteromedial portal, apply platelet-rich plasma at 7% to the tibial tunnel, the femoral tunnel, and the graft.

Steps

1.
Patient positioning
- I.
  After anesthesia induction, bilateral stability and range of motion is assess.
- II.
  Place a well-padded high-thigh nonsterile tourniquet.
- III.
  Shift the patient closer to the leg post to produce a proper valgus when needed.
- IV.
  After sterile drape, an assistant should drop the end of the bed allowing a 90° flexion.
2.
Diagnostic arthroscopy
- I.
  Through the standard portals (anteromedial and anterolateral), pay special attention to the integrity of the other ligaments, the femoral notch width and the presence of associated injuries.
3.
Graft harvest
- I.
  With the patient's knee flexed 90°, perform a 3-cm long incision over the pes anserinus.
- II.
  To protect the medial collateral ligament, elevate the sartorial fascia from proximal to distal with a blunt object.
- III.
  Longitudinally incise the sartorial fascia and expose the gracilis and semitendinous tendons.
- IV.
  Release the deep portion of the sartorial fascia with a blunt right-angle clamp.
- V.
  Whip stitch the ends of both tendons.
- VI.
  With a striper harvest the tendons from distal to proximal.
4.
Graft preparation
- I.
  Remove muscle fibers and unstable portions from the grafts.
- II.
  Measure the length of each tendon to plan the correct graft configuration.
- III.
  Simulate the graft configuration to determine the appropriate length and diameter.
5.
Bone marrow cell harvest
- I.
  Insert a 14-gauge trocar through the anteromedial portal.
- II.
  Introduce the trocar 30 mm deep into the femoral notch apex.
- III.
  Turn off the arthroscopic fluid.
- IV.
  Remove the sty1et.
- V.
  Discard the first milliliter of blood.
- VI.
  With a 30-mL syringe preloaded with a heparinized solution slowly aspirate 60 mL of bone marrow.
6.
Biological augmentation
- I.
  Under direct arthroscopic vision through the anteromedial portal, apply platelet-rich plasma at 7% to the tibial tunnel, the femoral tunnel, and the graft.