PMC3767065_01
The FiberWire has been passed through the patellar tunnel and is subsequently brought through the tibial tunnel with a suture passer. The distal pole of the patella is identified with the arrow.
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Two transosseous tunnels were subsequently drilled following the general principles as described by Ecker et al. ; first, a 5.5 mm transverse tunnel through the patella, just distal to the mid-patellar level and then a 4.5 mm oblique tunnel behind the tibial tubercle, beginning proximally on the lateral aspect and extending distally to the medial aspect (Figure 1).
The patella height is set according to the Insall-Salvati ratio, using the FiberWire.
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This was confirmed using C-arm image intensifier with the knee at 30  of flexion (Figure 2).