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.