876 Foot & Ankle International 39(7) Figure 1. (A) Anteroposterior (AP) and (B) lateral knee radiographs showing an open, comminuted proximal tibial plateau fracture with extensive bone loss and an ipsilateral medial femoral condyle fracture in a 25-year-old male who was involved in a high-speed auto versus pedestrian collision. The patient sustained a popliteal artery injury with acute limb ischemia and severe soft tissue loss from the posterior aspect of the knee on presentation and was emergently placed in a knee-spanning external fixator with combined vascular repair using a proximal saphenous vein graft. (C) Three days after the initial vascular repair, the patient was found on clinical examination to have progressively worsening distal limb ischemia with evidence of early sepsis, necessitating an above-the-knee amputation. 4. 5. The surrounding fascia and muscles are dissected and amputated and the major vessels are suture ligated. The femur is cut using an oscillating saw typically 12 cm above the joint line, but as much femoral length should be kept as possible. The sciatic nerve is ligated and transected proximal in the wound to prevent painful neuroma formation. The edges of the distal femur are smoothed down using a small saw or rasp to avoid postoperative stump irritation in a prosthesis. The adductor magnus is tensioned across the end of the femur to the anterolateral side and any excess length from the tendon is sharply removed. 6. Then, the adductor is secured using a locked Krackow suture with FiberTape with 4 to 5 passes proximal and distal (Figure 2). It is important that the FiberTape is pulled through the tendon such that the widest portion of the suture is embedded in tendon and the short end is left distally. An advantage of the FiberTape is that its flat, thick shape increases the contact surface area between suture and tendon, therefore increasing fixation strength. All of the slack should be removed from the suture after each locking pass to ensure solid tendon fixation. An additional Krackow FiberTape suture can be used for additional fixation in larger patients or those with poor adductor tendon tissue quality.