A Technique for Augmenting Bone Graft in the Tibial Tunnel During Anterior Cruciate Ligament Reconstruction Using Single-Tendon Hamstring Autograft.

Abstract

This article presents a technique to enhance graft-tunnel integration in anterior cruciate ligament reconstruction using a single-tendon hamstring autograft. The method involves injecting a calcium sulfate-calcium phosphate composite (Pro-Dense Injectable Regenerative Graft; Stryker) into the residual space between the distal graft and the tibial cortex. After preparation of a quadrupled semitendinosus graft with cortical suspension devices at both ends and a tibial fixation button, anatomically positioned femoral and tibial tunnels are created, and the graft is passed and fixed. The injectable graft material is delivered under controlled conditions to fill the tibial-tunnel void and support biological healing. Early application of this technique has shown ease of use, adequate tunnel filling, and no extravasation, with postoperative imaging confirming proper positioning. This approach addresses a critical biological limitation in anterior cruciate ligament reconstruction by enhancing tibial-tunnel integration. Although early results are promising, further studies are needed to evaluate long-term outcomes, including tunnel widening, graft incorporation, and functional performance.