Patellar Tendon Repair With Ipsilateral Semitendinosus Autograft Augmentation

Abstract

Patellar tendon ruptures are rare but potentially devastating injuries. Acute repair after patellar tendon rupture affords the best opportunity for tension-free restoration of the extensor mechanism. Biological augmentation of primary repair is believed to decrease strain across the repair site and reduce the risk of rerupture. We present a technique for primary patellar tendon repair with bidirectional fixation using transosseous tunnels, suture anchor fixation, and ipsilateral hamstring autograft augmentation in a distal patellar pole socket.

Fig 1

Left knee arthrotomy with exposure of a torn patellar tendon. Two No. 2 FiberWire locking whipstitch sutures (arrows) have been placed. (DPT, distal patellar tendon remnant; P, patella.)

Fig 2

Left knee arthrotomy with exposure of a torn patellar tendon. The patellar instrumentation required for transosseous suture fixation with semitendinosus augmentation and bidirectional fixation is shown. (A) A spade-tipped drill is positioned at the distal pole of the patella (arrow), aiming to the proximal pole in the middle third of the patella. (B) Medial and lateral transosseous tunnels are drilled (arrows) parallel to the central tunnel. (C) FASTak (F) suture anchors are placed, leaving a minimum 5-mm osseous bridge between all devices. (D) A 5- to 6-mm cannulated reamer (CR) is passed over the spade-tipped pin to a depth of 10 mm to create the autograft socket.

Fig 3

Left knee arthrotomy with exposure of a torn patellar tendon and a patella previously reamed in preparation for semitendinosus autograft placement into a patellar socket. (A) A TightRope button has been secured over the superior pole of the patella, and the proximal sutures are being used to shuttle the tendon into the socket. (B) The semitendinosus tendon is bottomed out within the 10-mm patellar socket. (A, autograft; DP, distal patella; PP, proximal patella.)

Fig 4

Left knee arthrotomy with semitendinosus graft augmentation after transosseous repair of a patellar tendon tear. (A) The autograft is tensioned and sutured to the native patellar tendon (arrow) to the level of the tibial tubercle. (B) The autograft tendon is folded proximally and then incorporated into the medial and lateral retinacular repairs to create a 4-stranded augmentation construct.