The following is a technique demonstration for a quadrupled semi-tenosis graft. This will be done with suspension fixation loops on the femoral and tibial side, but certainly could be modified for fixation, especially on the tibial side if need be. So the length of this graft, as you see here, is 265 millimeters, which is typical. It's going to be quadrupled through the two loops. So one end of the graft is passed through the left loop, which I'll call the femoral loop, and back through the right loop, which I'll call the tibial loop. And then I reach back through the femoral loop, passing the other end of the graft through the tibial loop. And now you can see, when I bring them together, I just have to secure them, and I'll have a closed-loop quadrupled construct. So I pass a stout suture, holding both limbs of the overlap of the two free ends, two passes on the top and then two from underneath, grabbing both limbs of the graft, as you see here. And then once I tie the two ends of this suture, I'll have closed the loop and linked the two free ends. And this is a nice, secure suturing pattern, as I showed you. So I just simply tie that, but I leave these two limbs long, and you'll see why in a second. Now I'm going to pretty up the graft, put a little traction on it, and I'm going to slide the sutured ends more up into the apex of the femoral loop. And then you can use the two sutures here to your advantage by pulling them and securing them to the cleat of the prep station, as seen here. Now you're tucking that sutured end right in the apex of the femoral loop. Slight traction. Now I'm going to link the four limbs. I pass the strong suture through the upper two limbs, wrap it around all four, then come from below and pass it through the lower two limbs, meeting in the middle. You can see I have a short suture from the initial pass, and then I simply tie that securely with a good knot. Then I'll cut the short end, as you see here, and then I'll utilize the needle to dunk the knot here. Cut that. And then at this point, I put the graft under further tension, approximately 15 pounds, which is 75 newtons.

quadrupled semi-tenosis graft

suspension fixation loops

femoral and tibial sides

suture technique

graft tensioning