Anatomic All-Inside Anterior Cruciate Ligament Reconstruction With a Modified Lemaire Extra-Articular Tenodesis: Quadruple-Bundle Semitendinosus Autograft and Surgery Tips.

The past decade has seen changing trends in anterior cruciate ligament reconstruction surgery, with the hamstring becoming the most commonly used graft. Furthermore, the importance of extra-articular lateral tenodesis has been demonstrated to offer greater control of rotational laxity and a protective effect during cruciate ligament reconstruction. In this technical note, we describe a way to elaborate the graft with quadrupled semitendinosus tendon to obtain a compact and reliable graft. We provide tips and tricks to systematize and simplify the "all-inside" reconstruction technique and modified Lemaire's extra-articular tenodesis with femoral fixation in an independent bone tunnel under direct visualization to avoid confluence of the bone tunnels. This is a safe, reliable, and reproducible technique that causes less morbidity by removing a single hamstring tendon and preserving bone stock, with good clinical and functional results.