# Quadriceps-Bone-Block Autograft Anterior Cruciate Ligament Reconstruction With Tibial Interference Screw Aperture Fixation and Suture Tape Reinforcement

## TL;DR

This paper introduces a new surgical technique for ACL reconstruction using a suture tape to reinforce the graft and improve outcomes.

## Contribution

A novel extra-articular shuttling technique for suture tape reinforcement with tibial aperture fixation in ACL reconstruction is presented.

## Key findings

- Independent suture tape reinforcement can increase graft yield strength and improve clinical outcomes.
- Existing techniques for suture tape reinforcement with tibial aperture fixation are overly complex.
- The proposed technique simplifies suture tape reinforcement for quadriceps-bone-block autograft ACL reconstruction.

## Abstract

Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopaedic surgical procedures. The risk of clinical failure after isolated ACL reconstruction in high-risk populations is as high as 40% at 2 years postoperatively. Multiple strategies exist to decrease the risk of rerupture after ACL reconstruction, including manipulation of the graft source and diameter, optimization of the femoral and tibial tunnel position, addition of concomitant extra-articular procedures, and graft support with synthetic material. Independent graft reinforcement with a high-strength, nonabsorbable suture tape has become a popular, low-cost, low-morbidity technique to increase the graft yield strength, decrease graft stretching, improve clinical outcomes, and decrease rerupture rates. However, most suture tape reinforcement techniques require suspensory fixation of both the femoral and tibial sides, with no alternative for bone-block aperture fixation. Furthermore, the existing techniques for independent suture tape reinforcement with tibial aperture fixation are overly complex, requiring intra-articular shuttling of thick, multi-braided suture limbs. We present a simple, extra-articular shuttling technique for independent suture reinforcement of quadriceps-bone-block autograft ACL reconstruction with tibial interference screw aperture fixation.