The four-bundle semi-t and gracilis graft is attached to the looped end of the graft passing guide wire and the number 5 Ti-Cron is drawn into the femoral tunnel. The graft is pulled into the tibial tunnel. The knee is hyperflexed, and the BioScrew guide wire is introduced through the low anteromedial portal and into the notch in the femoral tunnel. The guide wire should lie on top of the graft, not pushed into the graft. The wire is shoehorned on top of the graft as it is pulled into the tunnel.
Figure 6.60 shows the leader suture pulling the Endopearl and the graft through the notch. The graft is drawn up to the edge of the femoral tunnel, and the flexible BioScrew guide wire is laid on top of the graft at the notched region of the tunnel (Fig. 6.61). The graft and the flexible guide wire are pulled into the femoral tunnel. The graft is pulled up to the blue mark on the graft (30 mm). If there is graft hanging out the tibial tunnel, it is pulled further into the femoral tunnel. The graft should be inside the tibial tunnel in case the fixation needs to be augmented with a periosteal button.
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