Modified cross-pin femoral fixation using long needles, polydioxanone suture, and traction suture for hamstring anterior cruciate ligament reconstruction

The use of cross-pin femoral fixation in anterior cruciate ligament (ACL) reconstruction using semitendinosus and gracilis (ST/G) tendons has been shown to be biomechanically sound. As a result of some technical problems that we encountered, we modified the technique of the DePuy OrthoTech Xact ACL Graft Fixation System (DePuy, Warsaw, IN) using No. 2/0 polydioxanone suture (PDS) with long needles normally used for inside-out meniscal repair. In addition, a No. 5 Ethibond suture loop (Ethicon, Somerville, NJ) is used for traction of the ST/G graft up the femoral tunnel. Using a 2-suture loops technique, the traction suture loop offers a more effective in-line pull for the graft and it pulls the ST/G loops slightly higher than the alignment PDS. By so doing, it lessens the chance of kinking the alignment guidewire or even amputating the graft. Although not reported in literature, this type of graft complication is possible in other single-alignment suture or guidewire techniques.