Autologous Cancellous Bone Interposition to Enhance Tendon-Bone Integration in Hamstring Tendon Anterior Cruciate Ligament Reconstruction: A Surgical Technique.

Hamstring tendon autografts remain a popular choice for anterior cruciate ligament reconstruction due to their favorable biomechanical properties and reduced donor-site morbidity; however, delayed tendon-to-bone integration and tunnel widening continue to limit outcomes when compared with bone-patellar tendon-bone grafts. Biological augmentation with autologous bone offers the potential to improve both the biological and mechanical environment at the graft-tunnel interface. We describe a simple, reproducible, and cost-effective surgical technique that utilizes cancellous bone harvested during tibial tunnel reaming to biologically and mechanically augment hamstring tendon anterior cruciate ligament reconstruction. Using a 10-mL syringe sheath, bone reamings are collected, consolidated on the back table, and interposed within the graft and secured with circumferential 0-Vicryl sutures. The graft is then sized, inserted, and fixed with a femoral EndoButton and tibial interference screw. This approach provides a biologically favorable and mechanically stable construct using autologous bone readily obtained during routine anterior cruciate ligament reconstruction. It offers a pragmatic means to promote tendon-bone healing, enhance press-fit fixation, and potentially reduce tunnel widening without additional graft harvest or biologic adjuncts.