Quadrupled Semitendinosus Anterior Cruciate Ligament Reconstruction Without the Use of Tourniquet and Minimal Instrumentation: The “Double D” Technique

The hamstring tendons are among the most common autografts used for anterior cruciate ligament reconstruction. Typically, the ipsilateral knee's gracilis and semitendinosus tendons are harvested. More recently, studies have described the use of just 1 of the tendons (the semitendinosus [ST]) in a tripled or quadrupled configuration, particularly in all-inside reconstructions. Instead of using a double gracilis and ST, a quadrupled ST tendon allows for a graft with enough diameter to more closely mimic the natural anterior cruciate ligament while lowering the likelihood of graft rupture. The use of tourniquets has been reported to increase the risk of complications, particularly deep vein thrombosis. This Technical Note describes an anterior cruciate ligament reconstruction performed with a quadrupled ST, without the use of a tourniquet, and with only the reamers and a tibial guide as surgical instrumentation.