A Modified "Suspender-Type" Traction-Preservation and Native Ligament Reconstruction Using Hamstring Autograft for Anterior Cruciate Ligament Femoral-Side Avulsion.

Abstract

Anterior cruciate ligament rupture, a common sports-related knee injury, often causes instability and functional impairment and increases the long-term risk of osteoarthritis. Traditional remnant-preserving anatomical reconstruction is the first-line treatment for midsubstance tears, but optimal management of femoral-side avulsion injuries remains challenging. The vascular femoral attachment site offers unique healing potential. However, conventional reconstruction requires extensive native tissue resection, sacrificing the remnant's proprioceptive function and biological healing capacity, making it suboptimal. The presented modified "suspender-style" technique addresses this by combining native ligament repair via traction-reduction with graft-based reconstruction for mechanical support. This dual approach optimizes the healing microenvironment while maximizing proprioceptive preservation. Therefore, the surgical technique described in this article presents a viable surgical approach for anterior cruciate ligament reconstruction, applicable to Sherman type I injuries.