For PCL reconstructions with ST reinforcement (ALD-ALD ST group), the initial intra-articular distance between both bone tunnel exits was set to 40 mm. The graft and the ST were inserted into the bone tunnels without tensioning the graft. In step 1, the ST was fixated in the tibia using a 4.75-mm knotless PEEK (polyether ether ketone) anchor (Arthrex). Subsequently, the machine was moved slightly until 5 N was reached (step 2). That position was then defined as a simulated knee flexion angle of 90°, ensuring that the ST was equally loaded at 90° for all constructs.

For PCL reconstructions without ST reinforcement (ALD-ALD group), steps 1 and 2 were not performed because no ST was involved. The initial distance was set to 40 mm, which directly corresponds to a simulated knee flexion angle of 90°.

The femoral ALD was shortened until the graft was pulled into the femoral socket for a distance of 20 mm, allowing enough space for retensioning. The graft in the ALD-ALD and ALD-ALD ST groups was then slightly tensioned on the tibial site until a load of 50 N was reached and then knotted. This load level for the initial tensioning was chosen because during pretests, it was observed that moderate manually tensioning resulted in approximately 50 N.

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