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This tutorial demonstrates a five-stranded hamstring autograph technique, incorporating a single free limb into a four-strand suspensory button construct. The key objectives are to enhance the graft's cross-sectional area and biomechanical properties while ensuring sufficient graft length for tunnel fixation on both the femoral and tibial sides. The approach aims to minimize reliance on supplemental allograft, particularly in smaller patients, and to effectively integrate the free fifth limb into the graft construct. The semitendinosus and gracilis tendons are harvested using standard sharp and blunt dissection techniques, along with a closed tendon stripper. The semitendinosus tendon is evaluated for adequate length to form the necessary graft strands.
