# Modified Universiti Kebangsaan Malaysia Internal Bracing Graft Preparation Technique Using Allograft for Anterior Cruciate Ligament Reconstruction Surgery

## TL;DR

A new surgical technique using allografts and suture tape is introduced to improve anterior cruciate ligament reconstruction outcomes.

## Contribution

The modified internal bracing technique integrates suture tape within the graft to enhance biomechanical reinforcement and recovery.

## Key findings

- The technique provides immediate biomechanical reinforcement and reduces tunnel widening.
- Internal bracing prevents tunnel abrasion and stress-shielding effects in allografts.
- The method accelerates recovery by improving graft-tunnel integration.

## Abstract

Anterior cruciate ligament reconstruction using allografts is limited by delayed biologic incorporation and graft elongation, increasing failure risks during early rehabilitation. To address this, we describe the modified Universiti Kebangsaan Malaysia internal bracing technique, which integrates ultra-high-molecular-weight polyethylene suture tape within the graft construct. This technique aims to provide immediate biomechanical reinforcement, reduce tunnel widening, and accelerate recovery, particularly critical for allografts, which lack the initial strength of autografts. The tendons are then quadrupled over tri-fold loops of FiberTape (Arthrex), which is centrally positioned and secured with FiberWire (Arthrex). The construct is whipstitched with 2.0 Ethibond (Ethicon)—while suture contact with the FiberTape is carefully avoided—and preloaded with an ACL TightRope II Implant (Arthrex) and TightRope Attachable Button System (Arthrex) for femoral and tibial fixation, respectively. Additional GraftLink loop graft construct (Arthrex) stitches are placed at both ends to enhance graft-tunnel integration. This technique uniquely embeds the FiberTape internally within the graft structure to provide biomechanical reinforcement while preventing tunnel abrasion and stress-shielding effects.