Anderson transepiphyseal replacement of anterior cruciate ligament using quadruple hamstring grafts. A, Graphically enhanced lateral view from C-arm after drilling of femoral hole. B, Lateral radiograph of tibia, showing correct position of tibial guidewire. Although guidewire appears to enter tibial tubercle in this view, it actually enters epiphysis medial to tibial tubercle. C, EndoButton continuous loop passed around middle of double tendons and looped on itself. D, Semitendinosus and gracilis tendons pulled up through tibia and out of lateral femoral condyle with use of no. 5 suture in EndoButton. E, EndoButton washer is placed over EndoButton, and washer is pulled back to surface of lateral femoral condyle. F, Quadruple hamstring grafts secured distally by tying no. 5 FiberWire sutures over tibial screw and post. G, Radiograph 4 months after surgery, showing properly placed transepiphyseal tibial and femoral holes. SEE TECHNIQUE 51.21.