title: Multiple looping technique for tibial fixation in posterior cruciate ligament reconstruction using free tendon Achilles allograft.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The multiple looping technique for tibial fixation resulted in satisfactory outcomes from single-bundle PCL reconstruction without any significant complications.
  
  
  METHODS
  Therapeutic case series, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 200-701, South Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Noh
authors.affiliation: Department of Orthopaedic Surgery, Kyunghee University School of Medicine, Seoul, South Korea.
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Yoon
authors.affiliation: Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea.
authors.forename: Hee Soo
authors.initials: HS
authors.lastname: Kyung
authors.affiliation: Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, 1198, Kuwol-dong, Namdong-gu, Inchon, 405-760, Korea. ryhak@hanmail.net.
authors.forename: Young Hak
authors.initials: YH
authors.lastname: Roh
authors.affiliation: Department of Family Medicine, Daerim St. Mary's Hospital, Seoul, South Korea.
authors.forename: Tae Seok
authors.initials: TS
authors.lastname: Kang
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery; D000072229:Posterior Cruciate Ligament Reconstruction / Q000379:methods*; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery*; D014184:Transplantation, Homologous
keywords: Cruciate; Knee; Ligament; Multiple looping; Posterior