Anatomic Outside-In Reconstruction of the Anterior Cruciate Ligament Using Femoral Fixation with Metallic Interference Screw and Surgical Staples (Agrafe) in the Tibia: An Effective Low-Cost Technique

Ariel de Lima Diego1, 2, *, de Vasconcelos, Stemberg Martins1, 3, Leite, José Alberto Dias2, Pinto, Dilamar Moreira1, Teixeira, Rogério Beltrão1, de Léo, Álvaro Coelho1, Silveira, Leonardo de Lima1, 3, Gonçalves, Romeu Krause1, Gonçalves, Marcelo Carvalho Krause1, de Vasconcelos, Ana Carolina Leite1, Filho, Carlos Frederico Dias Costa1, de Lima, Lana Lacerda2
1 ITORK - Institute of Traumatology and Orthopedics Romeu Krause, Recife - PE, 50070-490, Brazil
2 Universidade Federal do Ceará, Fortaleza, CE Brazil
3 Hospital Armindo Moura Moreno, PE Brazil

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© 2017 Diego et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Av. Jõao da Escóssia 1300, casa 124. Cond Sun Ville. Bairro Nova Betânia. Mossoró Rio Grande do Norte 59607-330, Brazil; +55 (84)98776-2449; E-mails:,



An anterior cruciate ligament (ACL) rupture is a frequent injury, with short and long-term consequences if left untreated. With a view to benefitting as many patients as possible and preventing future complications, we created a low-cost ligament reconstruction technique.


The present article describes an anatomic ACL reconstruction technique.


The technique involves single-band reconstruction, using flexors tendon graft, outside-in tunnel perforation, femoral fixation with metal interference screw and surgical staples (Agrafe) in the longitudinal position.


We present a simple, easy-to-reproduce technique that, when executed on patients with good bone quality, primarily in the tibia, is effective and inexpensive, favoring its large scale application.

Keywords: Reconstruction, Anterior Cruciate Ligament, Low-cost, Interference Screw, Surgical Staple, Agrafe.