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Anterior cruciate ligament (ACL) rupture, one of the most frequent sports‐related knee injuries, predominantly occurs in athletic populations such as competitive athletes and young, physically active individuals. 1 , 2 After injury, it often manifests as significant anterior and rotational instability of the knee, restricted range of motion, and markedly impaired athletic function. 3 , 4 Moreover, it significantly elevates the risk of meniscal damage and articular cartilage injury, thereby increasing the long‐term incidence of secondary osteoarthritis. Therefore, active and effective intervention for ACL rupture is crucial for restoring knee function and preventing long‐term complications. In the clinical management of ACL rupture, remnant‐preserving anatomical reconstruction has become the first‐line treatment for midsubstance ACL tears. This procedure uses arthroscopic‐assisted autologous tendon grafting to reconstruct the ligament at its anatomical position, thereby restoring the biomechanical stability of the knee. 5 , 6 When an ACL rupture occurs at the femoral footprint, remnant‐preserving anatomical reconstruction typically requires the resection of a significant portion of the avulsed native ACL tissue. This is done to prevent notch impingement by the free end, preserving only a small portion of the remnant ligament tissue on the tibial side. Although this procedure achieves mechanical reconstruction, it largely sacrifices the native ligament's inherent proprioceptive nerve endings and biological healing potential. 7 Proprioception is critical for joint position sense, kinesthesia, and neuromuscular control, serving as the foundation for achieving high‐level functional recovery. 8 , 9 , 10 Therefore, for ACL ruptures occurring at the femoral footprint, direct resection of the native ligament may not represent the optimal therapeutic strategy.

In recent years, the goal of surgical treatment has evolved from purely mechanical reconstruction to restoring stability while striving to preserve and harness the biological function of native tissue. Several studies have reported the use of isolated anatomical repair for the treatment of femoral‐side avulsions of the ACL. 11 , 12 , 13 Although this procedure can harness the biological function of native ligament tissue, it possesses an inherent and critical limitation: the repaired native ligament often shows insufficient mechanical strength, failing to withstand high‐intensity athletic loads. As a result, it does not meet the therapeutic demands of competitive athletes and patients with high activity levels, which restricts its clinical applicability. In pursuit of an optimal balance between mechanical strength, biological healing, and proprioceptive function, we describe the modified “suspender‐type” traction‐preservation and native ligament reconstruction technique (Video 1). This technique uses a “suspender‐type” traction‐reduction approach to accurately repair the femoral‐side avulsion of the native ACL, while concurrently incorporating a reconstruction component to establish robust mechanical support. It thereby creates a more favorable healing microenvironment for autograft integration while maximally preserving the proprioceptive function inherent to the native ligament.

This technical note focuses on the application of this technique for treating femoral‐side ACL avulsions. It aims to systematically elucidate its key procedural details, provide a superior surgical alternative for this specific injury pattern, and ultimately contribute to improved patient outcomes and successful return to sports.