Introduction: Arthroscopic ACL Reconstruction by semitendinosus tendon graft is widely used nowadays, especially, by using the single incision technique, and endobutons proximal fixation.

Material and methods: The study includes 60 patients that had ACL reconstruction 2 to 5 months after injury. The semitendinosus was harvested, triple folded and attached to the endobutton. After introduction of the graft, it was fixed distally by the use of two staples. Clinical assessment after an average duration of 20 months (range: 18–26 months) was performed according to Tegner and Lysholm scoring scale.

Results: According to Lysholm scoring scale, excellent results (95–100 points) were obtained in 26 patients (43.3%), good results (85–95 points) in 29 patients (49%).

According to Tegner scores, the average score increased from 3.2 preoperatively, to 6.1 postoperatively. 32 patients (53.3%) returned to the same sports.

Four early failures occurred (6.6%) after mild twisting injury. All four had lateral or posterolateral corner injury, which were not addressed at the time of ACL reconstruction.

One patient had ACL rupture after a significant tortional trauma.

Conclusion:

1) ACL reconstruction using triple semitendinosus tendon, is a viable technique compared to other studies.

2) Associated ligamentous injuries must be treated at the time of ACL reconstruction.

3) Preserving Gracilis tendon, decreases hamstring morbidity.