The 4‐Strand Hamstring Overlap Link for All‐Inside Anterior Cruciate Ligament Reconstruction: Graft Preparation Technique

Anterior cruciate ligament (ACL) injury is among the most prevalent sports‐related knee injuries. Arthroscopic ACL reconstruction (ACLR) is the standard minimally invasive surgical treatment for ACL injuries. The all‐inside technique, as a significant recent innovation in ACLR, has become an important clinical option due to its advantages of reduced invasiveness, stronger graft constructs, and less early postoperative pain. However, a consensus on the optimal tendon preparation technique for all‐inside ACLR has yet to be established. This article details an overlapping suture graft preparation technique for a 4‐strand autologous hamstring tendon graft, augmented with an internal brace and specifically designed for all‐inside ACLR. This technique maximizes the utilization of autologous tendon tissue, ensures uniform tension distribution across all strands, eliminates midsubstance gaps, and facilitates functional ACL restoration while promoting graft‐bone integration.