For all-inside constructs (ALD-ALD and ALD-ALD ST groups), bovine tendons were placed on a graft preparation station. The tendon was passed through a TightRope RT (Arthrex) for femoral fixation and a no-button TightRope TN (Arthrex) for tibial fixation, leaving 1 longer and 1 shorter-end. The long tendon end was again passed through both devices until the tendon ends met to create a quadrupled graft construct. Graft ends were overlapped for approximately 5 mm and then U-stitched together using a No. 0 FiberWire (Arthrex), forming a continuous loop. Before the first linked stitch, the graft construct was exposed to an initial tension of 20 N. The graft construct was completed using 3 further linked stitches under a tension of 80 N. The preparation of the all-inside grafts without additional ST is illustrated in Figure 1A. The additional ST for the ALD-ALD ST group was threaded through the femoral button, allowing for independent fixation of the ST. The final quadrupled graft construct measured 90 mm in length and 10 mm in diameter, representing a standard allograft in PCL reconstruction.1,24 The final construct is illustrated in Figure 2.

(A) Preparation and final construct of all-inside quadrupled grafts (ALD-ALD and ALD-ALD ST groups) without suture tape (ST). (B) Final construct of screw fixation constructs (Screw-ALD and Screw-ALD ST groups) without ST. ALD, adjustable loop device.

Illustration of final all-inside posterior cruciate ligament reconstruction with additional suture tape.

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