title: Quadriceps tendon repair using hamstring, prolene mesh and autologous conditioned plasma augmentation. A novel technique for repair of chronic quadriceps tendon rupture.
abstract: BACKGROUND
  Several techniques have been described for the primary repair of quadriceps tendon ruptures but there is a paucity of literature on operative management of chronic/recurrent quadriceps tendon ruptures. We describe a novel technique for the revision of quadriceps tendon ruptures which uses hamstring, prolene mesh and autologous conditioned plasma augmentation.
  
  
  METHODS
  Our patient was an independently mobile, active 61 year-old man who sustained staggered, bilateral quadriceps tendon ruptures. He had two failed direct repairs on the left side. The patient was unable to actively extend his knee. On the third attempt, despite maximising quadriceps tendon length using the Codivilla technique the gap remained significant. The left and right semitendinosus and left gracilis tendons were thus harvested and used to augment our repair. A prolene mesh, sized to fit the whole length quadriceps tendon and patella, was then secured to the repair to reinforce it. The repair site was finally injected with autologous conditioned plasma.
  
  
  RESULTS
  Satisfactory post-operative outcomes were achieved. The patient was pain-free and able to maintain straight leg raise with a 10 degrees extensor lag at his four months review in clinic.
  
  
  CONCLUSIONS
  We were able to achieve a stable construct with combination of both well-established and novel tendon lengthening techniques, in addition to mesh and biological augmentation. In our experience this surgical procedure is suitable for the treatment of a large tendon gap defect and will withstand high force transmission.
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, United Kingdom.
authors.forename: Haroon
authors.initials: H
authors.lastname: Rehman
authors.affiliation: Dr Gray's Hospital, Elgin, Moray IV30 1SN, United Kingdom. Electronic address: peterkovats@btinternet.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Kovacs
mesh_terms: D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011126:Polypropylenes; D052097:Quadriceps Muscle / Q000293:injuries; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012421:Rupture; D013526:Surgical Mesh; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery*
chemical_list: D011126:Polypropylenes
keywords: Novel chronic quadriceps tendon repair