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were going to be demonstrating graph preparation for all inside ACL reconstruction using a quadrupled semitendinosus tendon to make the graph link as you can see the graph measures 27 centimeters in length and this can be quadrupled and with a 27 centimeter graft this gives between 65 and 70 millimeters in length for the graph link the ACL tightropes are loaded onto the graph preparation station such that all graph preparation can be carried out without an assistant first we take a small hemostat and bring the end of the semitendinosus graft through the first ACL tightrope and then through the second this thing creates a short length and a long length as can be seen the longer end is then brought back through both ACL tight ropes to create a quadruple graft with two free ends to free ends are then sutured together with a mattress suture using zero fiber wire in isolation the pullout strength of this knot is not great but once its been incorporated into the graph link weve tested the
