Steps in preparation of ST graft. (A) Pen marks are placed at the previously measured graft length, minus 0.5 cm, and at a point closer to the tibial insertion of the ST tendon to obtain a minimum graft length of 8 cm for the tripled or quadrupled graft portion. The graft is (B) doubled, (C) then tripled, and (D) finally (if required), quadrupled over a TightRope RT between these 2 pen marks. (E) The looped graft is sutured to itself.