Abstract
General Principles
Repairs should be immobilised in full extension for 6–8 weeks. Gradual resumption of motion in a hinged brace over an additional 6–8 weeks almost always yields flexion to at least 90 degrees.
Acute tibial tuberosity avulsion
Open repair is best accomplished with a non-absorbable heavy Krackow suture, secured distally around a screw and washer followed by 6–8 weeks of immobilisation. Augmentation with a semitendinosus graft can provide additional structural support.
Acute Patella Tendon Rupture
End to end repair is standard, but re-rupture is not uncommon, so supplemental semitendinosus reconstruction is recommended. The tendon is harvested proximally, left attached distally and passed through a transverse hole in the inferior patella. The gracilis tendon can be harvested and sutured to semitendinosus for additional length, if needed.
Acute Quadriceps Tendon Rupture
These can be repaired end to end with a non-absorbable heavy Krackow suture. A superficial quadriceps fascial turn-down may be a useful adjunct.
Patella Fracture
Treatment depends on the status of the patellar component and the loss of active extension if the component remains well fixed and the patient has less than a 20 degree lag. A loose component and/or >20 degree extensor lag requires ORIF +/− component revision.
Chronic Disruptions
While standard repair techniques are possible, tissue retraction usually prevent a “tension-free” repair. In most chronic disruptions complete allograft extensor mechanism reconstruction is preferable. If the patella itself has not retracted proximally and remains intact, other allograft soft tissues are a viable alternative. All grafts should be repaired tightly with the knee in full extension.
