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Hematoma within the disrupted tendon is
evacuated. The stumps are sutured end-to-end
with 3 “U” knots with nonabsorbable sutures
(n° 2 Fiberwire). This suture is reinforced by
single stitches with an absorbable suture
(Vicryl). A PDS tape is used to augment and
protect the suture: biomechanically it transforms
distraction forces into compression forces. It is
folded in half and fixed on the tibial tubercule
with a staple (Orthomed). The two free ends
are sutured in a V-shape on the patellar tendon,
on the patellar periosteum, and finally on the
quadriceps tendon. This is done at 60° of knee
flexion to avoid patellar tendon shortening and
patella baja. An intraoperative radiograph is
done to check the patellar height [18].
In case of diastasis of the suture, we augment it
with a semitendinosous autograft. The semi-
tendinosous tendon is harvested. A 4.5mm
transosseous tunnel is drilled through the ATT
and another through the distal part of the
patella. The semitendinosous tendon is passed
through these two tunnels and the two free ends
are sutured end-to-end while the knee is
extended. The graft is also sutured side-to-side
with the patellar tendon and the patellar
periosteum. This technique creates a box
around the patellar tendon. Another option is to
harvest an 8cm long – 15mm width quadriceps
tendon autograft left inserted on the anterior
side of the patella. The graft is flipped down
and sutured to the patellar tendon, covering the
suture of the tear. Whatever the technique used,
the postoperative course is similar to that
described earlier [18].
Other techniques are described in the literature
[9]. For example, in cases of patellar tendon
rupture at the osteotendinous junction, the free
end of the tendon is freshened and two n° 5
nonabsorbable sutures are then placed along
the medial and lateral halves of the patellar
tendon with an interlocking suture (Krackow).
The four free ends of suture are left emanating
from the proximal portion of the tendon and
passed through the patellar transosseous
tunnels. An ACL drill guide may be used to
place the patellar drill holes precisely. It is
important to ensure that the repair has not
produced patella baja. At 45° of flexion, the
inferior pole of the patella should be above the
roof of the intercondylar notch. The medial
and lateral retinacula are repaired with n° 0
absorbable sutures.
Alternatively, the patellar tendon may be
repaired with suture anchors rather than with
this transosseous technique. The sutures may
still be placed along the medial and lateral
halves of the patellar tendonwith an interlocking
technique (Bunnell or Krackow-Bunnell).
Results of Surgical Repair of
Patellar Tendon Disruption
As for quadriceps tendons, the results of acute
patellar tendon repair are favorable, regardless
of the position of the rupture or the method of
repair [15, 23]. However, delayed repairs have
worse outcomes. Range of motion approaching
that of the contralateral knee is regained and, in
athletic individuals, premorbid activity levels
and strength can be expected. Complications
include rerupture, wound problems, and
patellofemoral symptoms. Rerupture is
generally related to return to rigorous activity
before completion of proper physical therapy.
Wound complications are more common than
with quadriceps tendon disruption because of a
thinner skin over the tibial tubercle; therefore,
it is recommended incise skin adjacent to the
tubercule but not directly on it. Obtaining an
intraoperative radiograph at completion of the
patellar tendon repair is useful to ensure patella
is not baja.
Conclusion
Acute quadriceps and patellar tendon ruptures
are rare and must be actively searched. Acute
diagnosis and repair are mandatory to achieve
an optimal functional recovery.