Anterior cruciate ligament reconstruction with the use of autogenous hamstring tendon grafts is a well-recognized procedure. Initially, the semitendinosus and gracilis tendons were harvested and used as two-strand autografts for reconstruction of the deficient ACL, but concerns about strength led to the use of four-strand constructs. Creating a four-strand graft, by folding the tendons in half, decreases the length but increases the tensile strength and stiffness of the graft.

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