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today well be demonstrating a five stranded hamstrung autograph technique in which a single free limb of graft is incorporated into the four strand suspensory button construct our goals with this technique are to first to increase the cross-sectional area and hopefully the biomechanical properties of the graph while also leaving adequate graft for the tunnel fixation and fill on both the femoral and tibial side second is to try to avoid the routine utilization of supplemental allogram particularly in smaller patients and third is to try to utilize a technique in which we feel the free fifth limb of the graft is soundly incorporated into the overall graft suspensory button construct the semitendinosus and gracilis are harvested in standard fashion with a combination of sharp and blunt dissection and closed tendon stripper the semitendinosus is assessed for its maximum adequate length for a one double and one single stranded limbs of the graft typically the overall functional length of
