Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft and Modified Lemaire Extra‐articular Tenodesis Using a Single Femoral Tunnel

Abstract

The addition of a lateral extra‐articular procedure to anterior cruciate ligament reconstruction has been shown to improve rotational stability and reduce graft failure rates, particularly in high‐risk patients. However, tunnel convergence remains a major concern in combined anterior cruciate ligament reconstruction and lateral extra‐articular procedure techniques, as it may compromise graft integrity and lead to failure. This technical note describes a technique for anterior cruciate ligament reconstruction using a tripled semitendinosus graft, maintaining its tibial attachment, combined with a modified Lemaire extra‐articular tenodesis. The femoral tunnel is created using an outside‐in drilling technique, allowing both the intra‐articular anterior cruciate ligament graft and the lateral extra‐articular tenodesis graft to be secured within the same tunnel using a single interference screw. This approach simplifies the procedure by eliminating additional fixation devices and reducing the risk of tunnel convergence, while maintaining bone stock and cost‐effectiveness.