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In this video tutorial, graph preparation for inside ACL reconstruction using a quadrupled semitendinosus tendon is demonstrated. The graph measures 27 centimeters in length, which can be quadrupled to provide between 65 and 70 millimeters in length for the graph link. ACL tightropes are loaded onto the graph preparation station to allow for graph preparation without an assistant. The semitendinosus graft is brought through the ACL tightropes to create a quadruple graft with two free ends, which are sutured together using zero fiber wire. The pullout strength of this knot is not great in isolation but improves once incorporated into the graph link.
