Reconstruction of ruptured patellar tendon using semitendinosus and Gracilis tendon autograft: A modified technique

Background: Patellar tendon rupture is a relatively infrequent injury, resulting in severe morbidity if neglected or treated improperly. The treatment aims to preserve the extensor mechanism. Quite a few reconstruction techniques have been proposed. Still, most result in complications including contractures, adhesions & atrophy of the quadriceps tendon, fracture of the patella, damage to the patellar articular surface and patella Alta or Baja. We use a modified technique to reconstruct a ruptured patellar tendon using ipsilateral semitendinosus and gracilis autograft without making a trans-osseous patellar tunnel. Surgical technique: The patellar tendon is sutured using an end to end technique. The procedure involves harvesting and suturing semitendinosus, and gracilis tendons end to end. A horizontal tunnel of 4.5-mm diameter is drilled at a point one centimetre posterior to the tibial tuberosity. One free end of the graft is passed through this tunnel in a medial to the lateral direction and then placed in front of the patella in a figure-of-eight fashion. Each end is then introduced transversely through the distal end of the quadriceps tendon along the proximal margin of the patella. The two ends are pulled distally and placed in a figure-of-eight fashion again. Finally, the ends were sutured in between where they overlapped after adjusting the tension and the position of the patella. Conclusion: This modified technique reduces patella associated complications like fracture and patellofemoral cartilage damage. The figure of eight patterns allows the adjustment of graft tension as deemed required for keeping the patella in the ideal position. The load from the patella is directly transmitted to the tibial tubercle so that the repaired patellar tendon remains tension-free and can heal properly. Moreover, when the knee flexes, the patella is pulled downward and is prevented from anterior translation to stabilise the patella and maintain appropriate tracking. Most importantly, this technique avoids postoperative splinting and thereby facilitates early mobilisation and hence a better outcome.