{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:21:23Z","timestamp":1787736083456,"version":"build-2784847793"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Am. Podiatr. Med. Assoc.","JAPMA"],"abstract":"<jats:p>In foot and ankle surgery, allograft tendons are frequently used in both primary and revision cases to enhance stability and function. However, postoperative complications, such as creep, can compromise the intended correction and stability over time. This paper presents a practical guide on pretensioning techniques prior to implantation, aiming to reduce creep and improve long-term outcomes. Using two common allograft specimens, we demonstrate pretensioning methods with specific focus on tendon stitching, techniques for securing the allograft to the graft board, optimal tensioning and time parameters. We recommend pretensioning at 80 N for approximately 30 min to effectively decrease creep and maintain correction. This technique guide offers foot and ankle surgeons streamlined methods for tendon preparation to improve efficiency and consistency in the operating room.<\/jats:p>","DOI":"10.3390\/japma116050059","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:11:15Z","timestamp":1787731875000},"page":"59","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Allograft Tendon Pretensioning Technique Guide"],"prefix":"10.3390","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3021-9989","authenticated-orcid":false,"given":"Joseph R.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Foot and Ankle Surgery, OhioHealth Grant Medical Center, Columbus, OH 43215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Mendicino","sequence":"additional","affiliation":[{"name":"St. Clair Medical Group Orthopedic Surgery, Pittsburgh, PA 15423, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e582","DOI":"10.3928\/01477447-20150701-55","article-title":"Pretensioning of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction","volume":"38","author":"Pilia","year":"2015","journal-title":"Orthopedics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"484","DOI":"10.2106\/JBJS.15.00802","article-title":"Change in Size of Hamstring Grafts During Preparation for ACL Reconstruction: Effect of Tension and Circumferential Compression on Graft Diameter","volume":"98","author":"Cruz","year":"2016","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.arthro.2008.07.010","article-title":"Graft tensioning in anterior cruciate ligament reconstruction: A systematic review of randomized controlled trials","volume":"25","author":"Arneja","year":"2009","journal-title":"Arthroscopy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1007\/s00167-015-3530-y","article-title":"Lack of consensus regarding pretensioning and preconditioning protocols for soft tissue graft reconstruction of the anterior cruciate ligament","volume":"24","author":"Jisa","year":"2016","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.2106\/00004623-200605000-00018","article-title":"Viscoelasticity and temperature variations decrease tension and stiffness of hamstring tendon grafts following anterior cruciate ligament reconstruction","volume":"88","author":"Ciccone","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wang, W., and Xu, G.H. (2017). Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular Ligament in the treatment of chronic ankle instability. BMC Musculoskelet. 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Foot Ankle Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1007\/s00167-019-05362-0","article-title":"Clinical applications of allografts in foot and ankle surgery","volume":"27","author":"Diniz","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S0749-8063(96)90060-2","article-title":"Bone-patellar tendon-bone grafts for anterior cruciate ligament reconstruction: The effects of graft pretensioning","volume":"12","author":"Howard","year":"1996","journal-title":"Arthroscopy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1007\/s00264-016-3298-9","article-title":"Features of human autologous hamstring graft elongation after pre-tensioning in anterior cruciate ligament reconstruction","volume":"40","author":"Fujii","year":"2016","journal-title":"Int. Orthop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/036354659702500120","article-title":"Effects of initial graft tension on clinical outcome after anterior cruciate ligament reconstruction. Autogenous doubled hamstring tendons connected in series with polyester tapes","volume":"25","author":"Yasuda","year":"1997","journal-title":"Am. J. Sports Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1177\/0363546503261703","article-title":"Interference screw fixation of soft tissue grafts in anterior cruciate ligament reconstruction: Part 2: Effect of preconditioning on graft tension during and after screw insertion","volume":"32","author":"Nurmi","year":"2004","journal-title":"Am. J. 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