The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee, with injury usually occurring as a result of multidirectional sports. The incidence of ACL injury has continued to increase, with most patients opting for surgery to improve stability as well as permit a return to sport. Traditional methods of ACL reconstruction can achieve this but are not without their problems, including graft rupture, residual laxity, and donor-site morbidity. There is therefore a requirement for further research into newer, innovative surgical techniques to help improve complication rates. This article describes, with video illustration, ACL reconstruction using a reduced-size bone–patellar tendon–bone autograft with suture tape augmentation. The augmentation acts as a stabilizer during the early stages of graft incorporation while resisting against reinjury during an accelerated recovery. The ability to use a reduced-size graft decreases the donor-site burden, and retention of residual native ACL tissue, when possible, may help with proprioception.
Technique Video Video 1 Narrated step-by-step guide for anterior cruciate ligament (ACL) reconstruction with suture tape augmentation using reduced-size bone–patellar tendon–bone autograft. A standard midline incision is made for graft harvesting, aiming for a reduced, 7- to 8-mm bone–patellar tendon–bone autograft. The graft is then attached to a suture button with the suture tape running alongside it. Standard anterolateral and anteromedial portals are used, and the ACL remnant is preserved when possible without debridement. The tibial tunnel and femoral tunnel are prepared; the graft is then shuttled from distal to proximal using the lead sutures, and an interference screw is used to fix the bone plug in the femur. A bone anchor with both ends of the suture tape is placed just distal to the tibial tunnel with the knee in full extension. An interference screw is then inserted to secure the bone plug in the tibia with modest tension.