TTO fixation (A, B, C). A: anterior tibial tuberosity fixation. (B), (C): proximal fixation: the two bundles of the QT graft are passed through the native QT using three weaves per limb, according to the Pulvertaft technique. The graft was then secured with multiple non-absorbable sutures. During suturing, tension was applied in opposite directions on the allograft and native QT strands to ensure optimal tensioning of the reconstructed extensor mechanism.