Graft harvest and preparation
The semitendinosus and gracilis tendons will be harvested from the ipsilateral knee with a tendon harvester. Each tendon will be doubled over the ACL TightRope® 2 RT device (Arthrex, Naples, FL, USA) and the free ends sutured together with 2-Fibreloop suture (Arthrex, Naples, FL, USA) to create a 4-strand hamstring graft. If the graft diameter is less than 7mm in females or 7.5 mm in males, both tendons will be tripled to create a 6-strand construct. The length of the graft may be whipstitched with a 1 Vicryl suture to tubularise and compress the graft.