Patellarsehnenruptur 10 Jahre nach vorderem Kreuzbandersatz durch Patellarsehnen-Knochen-Transplantat

Autologous transplantation of the central third of the patella tendon with a bone-patellar tendon-bone (BTB) graft is one of the most commonly used techniques for anterior cruciate ligament (ACL) reconstruction. Frequently chosen alternative sources include semitendinosus and gracilis tendon autografts. The differences of opinion regarding graft sources mainly result from comparison of outcome and complications. Although higher donor site morbidity and postoperative extensor mechanism complications are postulated for bone-patellar tendon-bone grafts, patellar tendon ruptures following anterior cruciate ligament reconstruction are rarely reported in the literature. These predominantly occur during the early postoperative period. We present the case of a patellar tendon rupture in a healthy 36-year-old man, who suffered a skiing accident 10 years after uneventful ACL reconstruction with a BTB graft.     

ACL reconstruction using an abnormally thick autogenous patellar tendon graft.

This prospective study measured the patellar tendon thickness of 543 patients who underwent anterior cruciate ligament (ACL) reconstruction with an autogenous bone-patellar tendon-bone graft to document the normal range of patellar tendon thickness and to determine if using thicker than normal patellar tendons as an ACL graft source affected postoperative outcome. The postoperative results of 55 patients who underwent ACL reconstruction with a patellar tendon > or =7 mm thick (thick tendon group) were compared with those of 488 patients who underwent ACL reconstruction with a patellar tendon < or =6 mm thick (normal tendon group). 5 mm (4.5 mm in women and 5.3 mm in men) with a range of 3-11 mm (3-7 mm in women and 3-11 mm in men). There was no statistically significant difference in the postoperative KT-1000 arthrometer mean manual maximum difference (2.0 mm for grafts < or =6 mm thick and 1.9 mm for grafts > or =7 mm thick), postoperative quadriceps muscle strength scores, modified Noyes questionnaire subjective scores (mean of 91 points for grafts < or =6 mm thick and 92 points for grafts > or =7 mm thick), or postoperative stability and pain scores. These results indicate that an abnormally thick patellar tendon should not preclude the use of this involved tendon as a graft source for ACL reconstruction.     

Biomechanical study of ACL reconstruction grafts

There are no published studies describing the strength quadrupled gracilis tendon alone and quadrupled semitendinosus tendon alone in the configuration used for anterior cruciate ligament (ACL) reconstruction. The primary objective was to compare the mechanical properties of grafts used for ACL reconstruction during a tensile failure test. The secondary objective was to evaluate the effect of uniform suturing on graft strength. Fifteen pairs of knees were used. The mechanical properties of five types of ACL grafts were evaluated: patellar tendon (PT), sutured patellar tendon (sPT), both hamstring tendons (GST4), quadrupled semitendinosus (ST4), and quadrupled gracilis (G4). Validated methods were used to perform the tensile tests to failure and to record the results. Student's t‐test was used to compare the various samples. The maximum load to failure was 630.8N (± 239.1) for the ST4, 473.5N (± 176.9) for the GST4, 413.3N (± 120.4) for the sPT, and 416.4N (± 187.7) for the G4 construct. Only the ST4 had a significantly higher failure load than the other grafts. The sPT had a higher failure load than the PT. The ST4 construct had the highest maximum load to failure of all the ACL graft types in the testing performed here. Uniform suturing of the grafts improved their ability to withstand tensile loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1188–1196, 2015.     

Initial biomechanical properties of anterior cruciate ligament reconstruction autografts

To provide more information to consider when selecting a reconstruction technique, we did a side-by-side comparison of some of the initial biomechanical properties of currently accepted reconstruction methods. Our research hypotheses were that a quadrupled, woven semitendinosus and gracilis graft is as strong as any of the other commonly used graft materials and that quadrupling and weaving the hamstring graft may increase the stiffness of the overall construct Using lower extremity cadaveric specimens harvested from young donors, we fashioned seven each of seven types of graft: 9-mm, 10-mm, and 11-mm-wide patellar tendon graft (PTG); 10-mm-wide central quadriceps tendon graft; doubled semitendinosus graft; tripled semitendinosus graft; and quadrupled, woven semitendinosus and gracilis graft. Specimens were stripped of remaining soft tissue, and anterior cruciate ligament (ACL) constructs were created for biomechanical testing. The tibia was translated anteriorly on the femur, mimicking a pivot shift maneuver, andfailure strength, failure mechanism, and construct stiffness were recorded. No differences in mean strength were detected. The quadrupled, woven graft was significantly stiffer than the doubled semitendinosus graft and no less stiff than any of the PTG constructs. All grafts showed similar and adequate initial absolute strength to reconstruct the ACL. Quadrupling and weaving the semitendinosus and gracilis graft increases the stiffness of the reconstructed specimen to a level statistically similar to that of specimens reconstructed with a PTG.     

Hamstring tendon autograft better than bone patellartendon bone autograft in ACL reconstruction A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Background?Current debate on treatment options for anterior cruciate ligament (ACL) reconstruction complicate the choice between hamstring and bone patellartendon bone autografts. We hypothesized a priori that cumulative meta-analysis (a form of sensitivity analysis) might show that the evidence for reduction of morbidity by hamstring grafts could have been reached at an earlier time. Furthermore, we hypothesized a priori that modern state-of-the-art hamstring graft fixation technique would give similar results regarding stability as bone-patellar tendon-bone autografts.

Methods?We performed a cumulative meta-analysis and sensitivity analysis based on femoral graft fixation techniques to compare hamstring autograft and bonepatellar tendon-bone autografts in ACL reconstruction derived from a previously published meta-analysis.

Results?Cumulatively, that hamstring autograft reduces anterior knee pain had already reached statistical significance in 2001 (relative risk 0.49 (95%CI: 0.32–0.76; p = 0.001, I2 = 0%)). The modern endobutton hamstring graft fixation technique (2 studies) yielded similar stability in the Lachman test as bone-patellar tendon-bone grafts, with a relative risk of 1.1 (95%CI: 0.82–1.5; p = 0.6, I2 = 0%). Exclusion of the endobutton group explains the increased laxity in the hamstring graft group.

Interpretation?Cumulative meta-analysis strengthens the evidence for reduced morbidity using hamstring tendon autograft for anterior cruciate ligament reconstruction. Sensitivity analysis focusing on state-of-the-art hamstring graft fixation techniques further weakens the evidence that bone-patellar tendon-bone autografts provide better stability.     

Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft

BACKGROUND: Surgical reconstruction of the anterior cruciate ligament (ACL) is indicated in the ACL-deficient knee with symptomatic instability and multiple ligaments injuries. Bone patellar tendon-bone and the hamstring tendon generally have been used. In the present study, we describe an alternative graft, the quadriceps tendon-patellar bone autograft, by using arthroscopic ACL reconstruction. METHODS: From March of 1996 through March of 1997, a quadriceps tendon-patellar bone autograft was used in 12 patients with ACL injuries. RESULTS: After 15 to 24 months of follow-up, the clinical outcome for those patients with this graft have been encouraging. Ten patients could return to the same or a higher level of preinjury sports activity. According to the International Knee Documentation Committee rating system, 10 of the 12 patients had normal or nearly normal ratings. Recovery of quadriceps muscle strength to 80% of the normal knee was achieved in 11 patients in 1 year. CONCLUSION: The advantages of the quadriceps tendon graft include the following: the graft is larger and stronger than the patellar tendon; morbidity of harvest technique and donor site is less than that of patellar tendon graft; there is little quadriceps inhibition after quadriceps harvest; there is quicker return to sports activities with aggressive rehabilitation. A quadriceps tendon-patellar autograft is a reasonable alternative to ACL reconstruction in patients who are not suitable for either a bone-patellar tendon-bone autograft or a hamstring tendon autograft.     

Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction

Abstract Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages mid-to long-term clinical and functional outcomes after ACL reconstruction.     

Quadrupled bone-semitendinosus ACL reconstruction: a prospective clinical investigation in 100 patients

Abstract The hypothesis of our study was that a quadrupled bonesemitendinosus tendon graft could combine the advantage of bone-tobone healing with the high cross-sectional area of a quadrupled hamstring graft in ACL reconstruction. ACL reconstruction with a semitendinosus tendon graft was performed on 100 patients with isolated ACL injury from January 1996 to December 1999: femoral fixation was obtained with Endobutton and tibial fixation with Fastlok. Patients were evaluated for standard knee scores and functional strength tests, postoperative pain rating, knee radiographs taken after surgery and at final follow-up, magnetic resonance images at 3 and 6 months, isokinetic flexion-extension and internal-external rotation tests at 3, 6, and 12 months. Computerized laxity analysis was performed at final evaluation. Average surgical time was 85 minutes, including 13 minutes for graft preparation; 90% of the patients were discharged within 24 h. Subjective knee rating was 80%; kneeling test was positive in 7% and Werner score was 44 (range, 30–48). Lachman test was negative in 90% at final evaluation (mean follow-up, 38 months). Sensory changes at the anterior part of the proximal tibia were present in 30% at 3 months and 10% had definite hyposthesia. MRI showed graft incorporation at 3 months. Computerized laxity analysis revealed 90% with less than 3-mm side-to-side differences. Isokinetic testing showed normal hamstring and quadriceps peak torques at 12 months. The functional strength tests were normal by 6 months. Average Noyes score was 87.9, Lysholm score 93, and Tegner activity rating 6.0 (pre-injury, 6.1). IKDC score showed 90 normal or nearly normal knees, 9 abnormal, and one severely abnormal knee. Quadrupled bone-semitendinosus is a viable graft for ACL reconstruction and should be considered, especially in patients with pre-existing extensor mechanism problems.     

Research on strength of the grafts that are used in anterior cruciate ligament reconstruction]

Reconstruction of the anterior cruciate ligament (ACL) using autogenous tissue is a frequently performed procedure used to restore functional stability in ACL--deficient knees. The purpose of this study was to determine the structural mechanical properties of the ACL and the grafts that are used in anterior cruciate ligament reconstruction. We tested specimens of human tissue including: ACL, medial third patellar tendon B-PT-B, central third patellar tendon B-PT-B, gracilis tendon, semitendinosus tendon (single-stranded, double-stranded and quadrupled-stranded), distal iliotibial tract and plantaris tendon (single-stranded and double-stranded). Specimens were obtained at autopsy from 32 young male cadavers. Biomechanical tests were performed using the FPZ-100 machine (produced by VEB Rauenstein). The following grafts have shown higher values than ACL: quadrupled semitendinosus--229% of ACL, doubled semitendinosus--130% of ACL, central third patellar tendon B-PT-B--114% of ACL and medial third patellar tendon B-PT-B--107% of ACL. The following grafts have shown lower values than ACL: semitendinosus tendon--72% of ACL, gracilis tendon--49% of ACL, distal iliotibial tract--47% of ACL, doubled plantaris--18% of ACL and single plantaris--10% of ACL.     

Biomechanical comparisons of anterior cruciate ligament: reconstruction procedures with flexor tendon graft

An experimental study was conducted to compare the biomechanical characteristics of six currently available anterior cruciate ligament (ACL) reconstruction procedures with flexor digitorum profundus tendons. Forty porcine knees were divided into eight groups, of 5 knees each. In groups A, B, C, and D, the flexor tendon graft was fixed with sutures and an Endobutton, with 20-mm-wide polyester tapes and staples, with 10-mm-wide polyester tapes and an Endobutton, and with bone plugs and interference screws, respectively. In group E, the graft was fixed using a combined procedure of those in groups B and D. In group F, the graft was directly fixed with interference screws. In groups G and H, the bone-patellar tendon-bone graft was fixed with interference screws, and sutures, respectively. Each femur-graft-tibia complex specimen was tested with a tensile tester by anteriorly translating the tibia until failure. This study demonstrated that the biomechanical properties of the femur-graft-tibia complex reconstructed with the flexor tendon graft were significantly affected by synthetic fixation devices. Regarding the average maximal load of the groups with the flexor tendon graft, group B had the highest (893 N) and group C had the second highest (770 N). Groups E and A were in the third rank. Group F had the second lowest (312 N), and Group D had the lowest (230 N). The maximal load of group B was significantly greater (P < 0.01) than that of group G (656 N) with the bone-patellar tendon-bone grafts. As to clinical relevance, this study indicated that the flexor tendon graft can be an alternative substitute for the bone-patellar tendon-bone graft for ACL reconstruction, if we understand the biomechanical characteristics of each reconstruction procedure. Received: January 21, 2000 / Accepted: June 8, 2000     

The comparison of functional results of anterior cruciate ligament injuries treated with semitendinosus tendon and central one-third of patellar tendon autografts

The results of ACL reconstructions with autologus grafts taken from semitendinosus tendon and patellar ligament are presented. There were 78 patients in four groups. Patient age ranged from 15 to 47 years. The period of observation varied from 1 to 10 years, average 3.5. The first group consisted of 28 people treated with single semitendinosus tendon graft. In the second group there were 12 patients with acute ACL injuries treated by reinsertion of torn ligament attachment augmented by semitendinosus tendon. The third group of 18 persons had an ACL reconstruction with central one-third of patellar ligament fastened with thread loops on bone screws or staples. The last group of 20 patients had ACL reconstruction with central one-third of patellar ligament autograft. All patients were prospectively evaluated according to the Hospital for Special Surgery and the Lysholm and Gillquist scales. The statistical analysis clearly reveals the best results in the fourth group of patients, who had graft fixation with interference screws. Received: 4 April 2001/Accepted: 23 April 2001     

Anterior cruciate ligament reconstruction: Which graft is best?

For the last 4 decades, since the initial use of the patellar tendon for anterior cruciate ligament (ACL) reconstruction, there has been controversy regarding the ideal graft choice for this procedure. Beside bone-patellar tendon-bone autografts, several other graft choices have become popular, including hamstring tendon and a variety of allografts. Within the past 5 years, several randomized and nonrandomized studies have compared the graft choices in ACL reconstruction. However, the question still remains: Is there an ideal graft for ACL reconstruction? The purpose of this review is to assess the most recent data, identifying if there truly is an ideal graft choice.     

Anterior Cruciate Ligament Reconstruction

The bone-patellar tendon-bone has been widely used and considered a good graft source. The quadriceps tendon was introduced as a substitute graft source for bone-patellar tendon-bone. We compared the clinical outcomes of anterior cruciate ligament reconstructions using central quadriceps tendon-patellar bone and bone-patellar tendon-bone autografts. We selected 72 patients who underwent unilateral anterior cruciate ligament reconstruction using bone-patellar tendon-bone between 1994 and 2001 and matched for age and gender with 72 patients who underwent anterior cruciate ligament reconstruction using quadriceps tendon-patellar bone. All patients were followed up for more than 2 years. We assessed anterior laxity, knee function using the Lysholm and International Knee Documentation Committee scores, and quadriceps strength, the means of which were similar in the two groups. More patients (28 or 39%) in the bone-patellar tendon-bone group reported anterior knee pain than in the quadriceps tendon-patellar bone group (six patients or 8.3%). Anterior cruciate ligament reconstruction using the central quadriceps tendon-patellar bone graft showed clinical outcomes comparable to those of anterior cruciate ligament reconstruction using the patellar tendon graft, with anterior knee pain being less frequent in the former. Our data suggest the quadriceps tendon can be a good alternative graft choice. LEVEL OF EVIDENCE: Level III Therapeutic study.     

Revision anterior cruciate ligament reconstruction using the lateral third of the ipsilateral patellar tendon after failure of a central-third graft: a preliminary report on 10 patients

Long-term outcomes were reported for 10 (77%) of 13 cases of revision anterior cruciate ligament (ACL) reconstruction using the lateral third of the ipsilateral patellar tendon as a graft. All primary ACL reconstructions were ipsilateral central-third bone-patellar tendon-bone graft procedures. Mean age at follow-up was 30.7 years, and mean time from revision ACL surgery to follow-up was 42.9 months. At follow-up, average KT-1000 difference between knees was 2.4 mm. All patients had a negative pivot shift, extension within 5 degrees of the contralateral knee, and flexion within 15 degrees. Mean bilateral comparison ratios for isokinetic strength and hop testing were: extension, 83.5%; flexion, 96%; and single-leg hop 96.9%. No patella fractures or tendon ruptures had occurred. All patients had returned to their previous work level, and 8 of the 10 patients could participate in at least "moderate" sports activities (e.g., skiing and tennis). The results were comparable to published outcome reports for both primary and revision ACL reconstruction. The lateral third of the ipsilateral patellar tendon is a good graft option for revision ACL reconstruction.     

A METHOD OF PRE-OPERATIVE ASSESSMENT FOR POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

The use of the bone-patellar tendon-bone graft has been well established in anterior cruciate ligament (ACL) reconstruction. The value of this graft in posterior cruciate ligament (PCL) reconstruction has not been documented. A template was used to identify the origin and insertion of the PCL on standard lateral radiographs of the knee. Those patients who were found at arthroscopy to have an intact articular surface were measured using the template. Thirty-nine patients (40 knees) were included for study, the difference between the PCL and patellar tendon length was expressed as a percentage. The mean was 125% (range 98–165%). To assess the reproducibility of the technique, in 17 patients a repeat radiograph was taken and the two measurements compared. These were found to have a significant correlation (R, coefficient 0.79, P < 0.001). The use of autologous bone-patellar tendon-bone graft obviates the need for allograft with its incumbent problems. This method of measurement indicates that the patellar tendon graft would be long enough to be suitable for PCL reconstruction in the majority of cases.     

Recovery of extensor muscle strength in athletes after anterior cruciate ligament reconstruction

We investigated the effects of the use of different autograft materials on the early postoperative recovery of extensor muscle strength after anterior cruciate ligament (ACL) reconstruction. Reconstruction was performed in 172 athletes with ACL-deficient knees; in 32, a quadriceps tendon-patellar tendon substitute (QTS) was used; in 79, semitendinosus and gracilis tendons (STG) were used; and in 61, a bone-patellar tendon-bone graft (BTB) was used. For QTS and STG autografts, a ligament augmentation device was used. Each group received the same accelerated rehabilitation program. Muscle strength was measured periodically 3–18 months after the operation, using a Cybex II dynamometer (Cybex Division of Lumex, Ronkonkoma, NY, USA). Knee extensor strength was evaluated, using the side-to-side ratio and the body weight ratio, to give a precise assessment of permissible sporting activity. After a period of 1 year, the percentage of athletes who recovered their extensor muscle strength at a level more than 80% of that in the uninvolved knee was 15.6% for those with QTS grafts, 41.0% for those with BTB grafts, and 77.9% for those with STG grafts (P<0.001 between QTS and STG,P<0.05 between QTS and BTB, andP<0.001 between BTB and STG). The body weight ratio in men showed that, after reconstruction, recovery of extensor muscle strength sufficient for participation in vigorous sport required 6 months for STG grafts, 12 months for BTB grafts, and 18 months for QTS grafts.     

三种不同移植物重建前交叉韧带的疗效分析

目的 观察及比较关节镜下自体四股半腱肌肌腱、深低温同种异体骨-腱-骨(B-PT-B)复合体、LARS人工韧带重建膝前交叉韧带(ACL)的临床疗效.方法 对55例膝ACL断裂患者行关节镜下ACL重建术,根据重建ACL的材料来源分为自体四股半腱肌肌腱组(20例)、深低温同种异体B-PT-B复合体组(20例)、LABS人工韧带组(15例),并对3组在股四头肌肌力、关节稳定性、Lysholm膝关节功能评分等方面进行对比研究.结果 术后3个月股四头肌肌力恢复情况:LARS人工韧带组较自体组、异体组恢复快,而自体组与异体组无明显差异;术后3个月膝关节稳定性:LARS人工韧带组较自体组、异体组好,自体组与异体组无明显差异,Lysholm评分:自体组(86.3±4.1)分与异体组(88.6±3.8)分无明显差异,但LARS人工韧带组(95.4±4.2)分明显高于前2组(P＜0.05).术后12个月,3组股四头肌肌力恢复情况、膝关节稳定性、功能评分差异无统计学意义(P＞0.05).结论 关节镜下同种异体韧带、LAPS人工韧带重建膝ACL疗效满意,可作为自体材料的良好替代物,但患者所承担费用较高;LARS人工韧带可在术后早期进行膝关节功能活动.     

Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Background Current debate on treatment options for anterior cruciate ligament (ACL) reconstruction complicate the choice between hamstring and bone patellartendon bone autografts. We hypothesized a priori that cumulative meta-analysis (a form of sensitivity analysis) might show that the evidence for reduction of morbidity by hamstring grafts could have been reached at an earlier time. Furthermore, we hypothesized a priori that modern state-of-the-art hamstring graft fixation technique would give similar results regarding stability as bone-patellar tendon-bone autografts.

Methods We performed a cumulative meta-analysis and sensitivity analysis based on femoral graft fixation techniques to compare hamstring autograft and bonepatellar tendon-bone autografts in ACL reconstruction derived from a previously published meta-analysis.

Results Cumulatively, that hamstring autograft reduces anterior knee pain had already reached statistical significance in 2001 (relative risk 0.49 (95%CI: 0.32-0.76; p = 0.001, I2 = 0%)). The modern endobutton hamstring graft fixation technique (2 studies) yielded similar stability in the Lachman test as bone-patellar tendon-bone grafts, with a relative risk of 1.1 (95%CI: 0.82-1.5; p = 0.6, I2 = 0%). Exclusion of the endobutton group explains the increased laxity in the hamstring graft group.

Interpretation Cumulative meta-analysis strengthens the evidence for reduced morbidity using hamstring tendon autograft for anterior cruciate ligament reconstruction. Sensitivity analysis focusing on state-of-the-art hamstring graft fixation techniques further weakens the evidence that bone-patellar tendon-bone autografts provide better stability.     

Double-stranded hamstring tendons for anterior cruciate ligament reconstruction.

Bone-patellar tendon-bone autograft is the most commonly used tissue for ACL reconstruction; however, the harvesting of patellar tendon as a free graft can lead to significant morbidity. Alternate grafts may lower morbidity, yet the most commonly used alternate grafts including the double-stranded semi-tendinosus or gracilis have not been studied biomechanically. This study investigated the morphometric and biomechanical properties of double-stranded semi-tendinosus and gracilis tendons separately along with the patellar and quadriceps tendons obtained bilaterally from six fresh, 77-year-old cadaveric specimens. The quadriceps tendon was the thickest and therefore had the largest cross-sectional area, whereas double-stranded semitendinosus had the highest mean peak load to failure (1029+/-158.4 N), 11.5% and 10.3% stronger than patellar tendon and quadriceps tendons, respectively. Midsubstance rupture occurred in the hamstring tendons, whereas the patellar and quadriceps tendons failed at the bone-tendon junctions. Semitendinosus tendons with higher cross-sectional area had higher peak loads to failure. This linear relationship between cross-sectional area and the peak load to rupture also was observed in the other tendon groups (except gracilis). These results indicate that despite a lower cross-sectional area of the double-stranded semitendinosus, this tendon demonstrated a comparable mean peak load to rupture and stress compared with patellar and quadriceps tendons. It also was demonstrated that combined double-stranded semitendinosus and gracilis tendons produce a stronger graft with initial strength twice that of the patellar tendon, but requires further testing.     

Arthroscopic hamstring anteriorcruciate ligament reconstruction with endobutton femoral fixation

Numerous techniques of anterior cruciate ligament (ACL) reconstruction have been described in literature. All haveinherent advantages and disadvantages. Autogenous hamstring grafts provide adequate strength while avoiding donor site morbidity associated with bone-patellar tendon-bone harvest. Endobutton femoral fixation allows precise femoral tunnel placement without a second incision. This article describes our technique of endoscopie ACL reconstruction using a doubled semitendinosus autograft with Endobutton femoral fixation.