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Despite the early description, the exact placement of such cerclage wires remains unclear. The aim of the study was (1) to analyze how the cerclage elongates during knee flexion and (2) to define the insertion points with the most isometric behavior at the patella and tibial tuberosity (TT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>3D simulations of 10 healthy knees in the range from 0\u00b0 to 120\u00b0 of flexion using weightbearing computed tomography scans were generated. 12 insertion points were defined at the patella in equal distances along the lateral and medial border from the proximal to the distal pole. 42 insertion points were defined at the tibial tuberosity (TT) in a 3.0\u2009\u00d7\u20093.0\u00a0cm large grid around its center. An automatic string simulation algorithm was used to calculate the length for all possible combinations of the cerclage from 0\u00b0 to 120\u00b0 flexion. The most isometric combination of insertion points was found using the isometric score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most isometric insertion at the TT is distally (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and towards the center of the TT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). The most isometric points at the TT is located 61\u00a0mm distal to the joint line and 5\u00a0mm from the anterior border of the TT in a true lateral view fluoroscopy. The insertion on the patella is insensible, as long as the patella is not bypassed proximally (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elongation of patella tendon augmentation or cerclage can be reduced when choosing a distal and central insertion at the TT, while the insertion on the patella does not affect elongation as long as the patella is not by passed proximally. This might help to reduce excessive stress and prevent cerclage or augmentation failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06441-x","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T15:48:29Z","timestamp":1786031309000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Isometric points in cerclage for patellar tendon repair: a 3-dimensional, weightbearing computed tomography kinematic simulation"],"prefix":"10.1007","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6253-9824","authenticated-orcid":false,"given":"Christoph","family":"Zindel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Hodel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichao","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Meisterhans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro F.","family":"Fucentese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Vlachopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"issue":"8","key":"6441_CR1","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1007\/s00113-007-1269-8","volume":"110","author":"A Ahrberg","year":"2007","unstructured":"Ahrberg A, Josten C (2007) Augmentation of patella fractures and patella tendon ruptures with the McLaughlin-Cerclage. 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