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Following diagnostic arthroscopy and assessment of remnant quality, tibial and femoral tunnels are created using a transtibial approach with attention to graft isometry. Anterior cruciate ligament remnant fibers are selectively preserved and repaired using a cinch\u2010loop suture followed by an additional encircling stitch to form a sleeve\u2010like construct. A synthetic ligament is then passed through the prepared tunnels, and the repaired remnant is cofixed with the synthetic graft on the femoral side, allowing the remnant to envelop the graft. This technique provides immediate mechanical stability while preserving vascularized native tissue and neuromechanical elements that may support biological integration and proprioceptive preservation.<\/jats:p>","DOI":"10.1002\/atn2.70160","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:03:15Z","timestamp":1783652595000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transtibial Anterior Cruciate Ligament Reconstruction Using a Synthetic Graft Combined With Remnant Repair: A Hybrid Technique"],"prefix":"10.1002","volume":"15","author":[{"given":"Peng","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Joint and Sports Medicine First Affiliated Hospital of Dalian Medical University  Dalian China"},{"name":"Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases  Dalian Liaoning Province 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