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smith and nephews all inside acl reconstruction technique this technique offers controlled graft pre-tensioning pin guided retrograde drilling and ultra strong fixation begin preparing the graft by clipping one ultra button into each of the x-wing button holders the adjustable loops should face towards the center of the tensioner thread the tendon over the first ultra button and whip stitch the free ends together with mini tape loop suture on needle thread the tendon through the second ultra button and fold to create a quadrupled construct secure any free suture ends around the suture management post to hold in place place sutures at four points along the length of the construct ing to your preference apply tension to the graft by turning the handle on the x-wing until the desired tension has been achieved referencing the tension scale on the device size the graft diameter with the slotted sizing block the full femoral tunnel length can then be marked on the ultra button sutures to con
