Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 8, pp 2640–2645 | Cite as

Multiple looping technique for tibial fixation in posterior cruciate ligament reconstruction using free tendon Achilles allograft

  • Jung Ho Noh
  • Kyoung Ho Yoon
  • Hee Soo Kyung
  • Young Hak RohEmail author
  • Tae Seok Kang



This study was conducted to evaluate case series outcomes of a new tibial fixation technique using a free tendon graft during posterior cruciate ligament (PCL) reconstruction which is less affected by tibial metaphysis bone density.


Thirty-two subjects underwent single-bundle PCL reconstruction using a free tendon Achilles allograft. The graft was looped to be double stranded. The free ends of the graft were fixed to the femoral side using suture washer, and the looped end was fixed to the tibial side using the multiple looping technique. Range of motion of the knee and side-to-side difference were assessed at the last follow-up. The Lysholm Knee score was evaluated preoperatively and at the last follow-up. The Tegner Activity Scale score was evaluated before injury and at the last follow-up.


Twenty-eight subjects were followed up for at least 18 months. Mean follow-up was 27.7 ± 4.8 months. All subjects showed normal range of motion at the last follow-up. The mean side-to-side difference was 10.4 ± 2.8 mm preoperatively and 2.3 ± 1.8 mm at the last follow-up (p < 0.001). The mean Lysholm Knee score was 58 ± 9 preoperatively and 91 ± 5 at the last follow-up (p < 0.001). The median Tegner Activity Scale score was 7 (range 5–9) before injury and 6 (range 4–8) at the last follow-up (p = 0.001).


The multiple looping technique for tibial fixation resulted in satisfactory outcomes from single-bundle PCL reconstruction without any significant complications.

Level of evidence

Therapeutic case series, Level IV.


Knee Posterior Cruciate Ligament Multiple looping 

Supplementary material

Video Clip 1

Demonstration of creating the multiple loop between the Ligament Washer and a 17-mm Suture Washer in the tibial tunnel after inserting the tibial end of the graft into the tunnel. Each No. 2 Ethibond (green color) sling suture string is passed through each hole of a 17-mm Suture Washer, and both ends of the sling suture and one end of the No. 2 Fiberwire (white color) are tied together. Then, the closed loop of No. 2 Ethibond, which is tethered with No. 2 Fiberwire, is looped over the Ligament Washer in the tibial tunnel and the 17-mm Suture Washer on the anterior aperture of the tibial tunnel. The closed loop of the No. 2 Ethibond was circled five times over the Ligament Washer and 17-mm Suture Washer while holding the free end of the tethering No. 2 Fiberwire using hemostat to prevent entanglement in the tibial tunnel. Then, five winding looping suture was made over the Ligament Washer and 17-mm Suture Washer with a No. 2 Fiberwire. The tie is cut and the No. 2 Ethibond is removed (MOV 86956 kb)


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Jung Ho Noh
    • 1
  • Kyoung Ho Yoon
    • 2
  • Hee Soo Kyung
    • 3
  • Young Hak Roh
    • 4
    Email author
  • Tae Seok Kang
    • 5
  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineKangwon National UniversityChuncheon-siSouth Korea
  2. 2.Department of Orthopaedic SurgeryKyunghee University School of MedicineSeoulSouth Korea
  3. 3.Department of Orthopaedic SurgeryKyungpook National University HospitalDaeguSouth Korea
  4. 4.Department of Orthopaedic SurgeryGil Medical Center, Gachon University School of MedicineInchonKorea
  5. 5.Department of Family MedicineDaerim St. Mary’s HospitalSeoulSouth Korea

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