Anterior Cruciate Ligament Graft Preparation: A New and Quick Alternative to the Whipstitch

Abstract 

Anterior cruciate ligament reconstruction is a common procedure in orthopaedic practice. Hamstring autograft is increasingly becoming the graft of choice; however, there is little consensus as to the best method of graft preparation and, in particular, the efficacy of the use of a whipstitch with all tibial fixation systems. We propose a new, quick, and economical method of preparing the hamstring graft that involves securing a double loop of suture material around the tendon. This is achieved by passing a loop of No. 2 braided suture under the tendon; the free suture ends are then subsequently passed through the loop twice and tightened. This “loop-the-loop” traction suture allows the surgeon to apply adequate traction to the graft for tensioning while not compromising graft fixation. This new technique is faster than conventional whipstitching and has cost savings, because no needles are necessary. It is of particular help when using a central 4-quadrant sleeve-and-screw fixation device.

Key Words: Anterior cruciate ligament reconstruction, Hamstring, Graft preparation