Graft passage, tensioning and fixation technique
knee
The femoral button sutures will be passed through the femoral tunnel using the shuttling suture. The cortical suspensory button will be passed and confirmed to have flipped with a toggle test and reference to a marking on the tightrope corresponding to the femoral tunnel length and a second mark 7 mm closer to the graft. The graft will then be docked into the femoral tunnel, 5 mm short of the tunnel depth by shortening the adjustable loop. Two markings on the graft corresponding to the tunnel depth and 5 mm short of the tunnel depth as measured from the femoral end of the graft will be used to assess the amount docked into the femoral tunnel. The tibial side of the graft is then cycled 15 times with maximal manual tension applied. Following this, a proprietary “fish scale” tensioning device (Arthrex Inc, Naples, FL) is used to apply tension to the graft at 80N and an interference screw (PEEK; Arthrex Inc.) is placed over a nitinol wire with the knee at 0° of flexion with a posterior force on the tibia. The knee is then cycled through range of motion to ensure full range. The graft re-tensioned from the femoral side at 30° of flexion.