Growing participation in youth athletics has resulted in increased numbers of anterior cruciate ligament (ACL) injuries in skeletally immature patients. Use of autogenous graft material has been associated with improved graft survival. However, pediatric patients sometimes possess hamstring tendons that produce smaller-diameter grafts than those prepared with adult autogenous materials. Smaller-diameter grafts may predispose younger patients to graft failure. We describe a technique that increases the diameter of the ACL construct through the use of an 8-strand autologous hamstring tendon graft. The 8-strand ACL autograft is commonly used in all-inside ACL reconstruction surgery. R econstruction of the anterior cruciate ligament (ACL) in skeletally immature patients presents distinct challenges from that in the adult population. Whereas autograft ACL constructs can lead to donorsite morbidity, studies have shown improved graft strength and reduced revision rates, making autograft tissue favored in pediatric populations. 1-5The presence of open physes typically precludes the use of the boneepatellar tendonebone autograft in favor of a hamstring construct. Smaller patients, however, sometimes produce thinner final graft sizes because of smaller hamstring tendons.6-9 Because a smaller-diameter graft size is associated with increased need for revision ACL surgery, 9 maximizing graft thickness is essential. We describe a technique for preparing an 8-strand hamstring autograft that maximizes the diameter of the ACL construct while maintaining sufficient length for tibial and femoral fixation. TechniqueThe semitendinosus and gracilis tendons are harvested on the medial side of the proximal tibia by the surgeon's preferred technique. On the graft preparation table, the muscle at the proximal aspect of the tendons is cleared. The length of harvested tendon needed is dependent on the reconstruction technique used. To perform a transphyseal technique in patients with closing physes, the graft length used is between 26 and 28 cm to yield a graft length of 6.5 to 7 cm. To perform an all-epiphyseal technique in a pediatric patient with wide open physes, the total length of harvested tendon should be approximately 20 cm to yield a final graft length of 5 cm. The graft is prepared for an all-inside ACL reconstruction technique with button fixation on the distal femur and proximal tibia. We describe the graft preparation technique in this report and in Video 1.