Anterior Cruciate Ligament Reconstruction Using 4-Strand Hamstring Autograft: Conventional Single-Bundle Technique Versus Oval-Footprint Technique

Prepared graft is passed through the conventional sizing block (yellow color), which determines the large diameter. Thereafter it is passed through the Noh sizing block (metal), which determines the intermediate and small diameters.

Procedure for tibia tunnel: After the distal 30 mm of the tibial tunnel is made with a large-sized reamer, the remainder of the tibial tunnel is reamed with a medium-sized reamer. Thereafter the blunt end of the guide pin is inserted into the tibial tunnel and is held firmly on the PL border of the aperture by Kelly forceps through the AM portal during reaming with a small-sized reamer.

Procedure for femoral tunnel: A guide pin is inserted 30 mm at the 10:30 clock position through a 6-mm offset femoral tunnel guide transtibially. A 30-mm-deep femoral tunnel is made with a medium-sized reamer. After the guide pin is put on the PL wall of the femoral tunnel, it is held steady by use of a probe while drilling to the anterior femoral cortex. Thereafter the PL part of the femoral tunnel is made with a small-sized reamer. It is best to hold the drill tightly so as to keep the guide pin in place.