Anterior Cruciate Ligament Reconstruction Using a Hollow Ligament Advanced Reinforcement System Semitendinosus Autograft Combined With Anterolateral Complex Augmentation Using Gracilis.

Abstract

This technical note describes an alternative surgical technique for anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex (ALC) augmentation. The procedure uses a hollow ligament advanced reinforcement system (LARS), along with semitendinosus and gracilis tendons as grafts. Key surgical steps include arthroscopic exploration, graft preparation, tunnel drilling, and fixation. This technique reduces autologous tendon harvesting, reduces the risk of neurovascular injury, and facilitates immediate restoration of knee rotational stability with early postoperative mobilization. Nonetheless, potential limitations include the possibility of femoral positioning errors and a relatively steep learning curve. This method is particularly suitable for patients with thin autologous tendons, high athletic demands, or those undergoing revision ACL surgery, as it can augment smaller autologous grafts and confer immediate mechanical strength via the structural support of the hollow LARS ligament, thereby helping to maintain knee stability in the early postoperative period.