We report 97 quadruple hamstring ACLR reconstructed knees with 2 to 9.5 year follow-up. All procedures were arthroscopically assisted. The great majority were performed on an outpatient basis without pain pumps or femoral blocks. A low profile screw and washer was used in all cases as a tibial fixation post. Femoral fixation for most patients was with a single endobutton. The earliest patients in the study had a screw and washer used as a femoral post through a second incision. All patients had subjective and objective ALCR follow-up with modified Noyes, Lisholm and Sane ratings. All patients had KT 1000 tests and X-rays. Hamstring harvest was carried out via a new 1st posterior mini-incision technique developed by the senior author. Eleven year experience with this technique is described.

KT 1000 testing showed 93 patients with 0–3mm, and 4 patients with 4–5mm, side to side differences. No patient had 5mm or more side-to-side difference. There were no known graft failures and no re-operations for repeat ACLR reconstruction. There were no serious complications and there was no significant donor site morbidity. Range of motion was excellent, with no patient having a flexion contracture of as much as 5 degrees. There were no instances of endo-button migration or failure. ACLR ratings were high although some patients had minor pain or swelling with heavy use. Overall the procedure produced excellent stability and function with low morbidity.