# The Solo Anterior Cruciate Ligament Technique: Using an Articulated Arm Holder for Anterior Cruciate Ligament Reconstruction Without a Surgical Assistant

## TL;DR

This paper introduces a technique for performing ACL surgery alone using an articulated arm holder to manage the leg and a self-retractor for graft harvesting.

## Contribution

A novel solo ACL reconstruction method using an articulated arm holder and self-retractor to eliminate the need for a surgical assistant.

## Key findings

- An articulated arm holder can effectively manipulate the leg during ACL surgery without an assistant.
- A self-retractor aids in quadriceps tendon graft harvest and repair during solo ACL reconstruction.

## Abstract

The Federal No Surprises Act was passed to avoid surprise out-of-network billing to patients, particularly after surgical procedures from independent third parties hired as assistants. This has resulted in a scarcity of “for-hire” surgical first assistants. Anterior cruciate ligament (ACL) surgery is challenging to perform without an assistant. During arthroscopy, the leg must be manipulated simultaneously while performing surgery. This usually requires multiple hands and can be physically demanding. This Technical Note will describe the use of an articulated arm holder adapted to hold and manipulate a leg during ACL surgery without an assistant as well as the use of a self-retractor to aid in quadriceps tendon graft harvest and repair when performing a solo quadriceps tendon autograft ACL reconstruction.