Minimally Invasive Biological Gracilis Augmentation of Fascia Lata for Intra‐ and Extra‐articular Anterior Cruciate Ligament Reconstruction: XO FAST Technique

The fascia lata (FL) is a long‐established and proven graft for anterior cruciate ligament reconstruction, allowing intra‐ and extra‐articular reconstruction to be combined with a single graft and a single femoral tunnel, without femoral fixation. Despite its biomechanical and clinical advantages, its use has been limited by the morbidity of the donor site and the size of the incision. We describe a minimally invasive technique for anterior cruciate ligament reconstruction using a pedicled FL strip reinforced with the gracilis tendon, which reduces donor‐site morbidity while maintaining the benefits of combined reconstruction. This technique is based on reproducible anatomical landmarks for harvesting the FL, a limited lateral, and simplified graft preparation. The graft allows optimal control of anterior and rotational stability of the knee while preserving the extensor apparatus and the semitendinosus tendon. The absence of femoral fixation, the use of a single femoral tunnel, and a single tibial interference screw make this technique particularly suitable for pediatric surgery, revision surgery, and situations with a high risk of rerupture. This technical note presents a reliable and reproducible alternative to conventional techniques for reconstructing the anterior cruciate ligament using the FL, limiting morbidity while optimizing stability and functional outcomes.