title: Knee Extensor Mechanism Repairs: Standard Suture Repair and Novel Augmentation Technique.
abstract: Patellar and quadriceps tendon ruptures are relatively common injuries. Rupture of the knee extensor mechanism may occur because of a forceful eccentric contraction of the quadriceps against a resisted flexed knee, though atraumatic cases have also been described. Patients at higher than normal risk for knee extensor mechanism rupture include those with systemic co-morbidities, fluoroquinolone use, and chronic tendinopathy. Early operative treatment and mobilization of acute extensor mechanism ruptures has proven effective, and numerous techniques have been described. A 46-year-old male on anastrozole therapy simultaneously ruptured his left patellar and right quadriceps tendons during a deadlift attempt. Diagnosis was by history and physical examination. Repair of both injuries was performed 5 days after injury. Described within and shown in the accompanying video is a standard technique for primary repair using Krackow stitches through the ruptured tendon that are passed through patellar bone tunnels and tied over a bone bridge. The finer points of this technique are emphasized. Also included is a technique to augment the standard repair with a figure-of-8 stitch passed through additional oblique patellar bone tunnels. The mechanical advantage of the adjuvant figure-of-8 stitch provides additional compression, which nicely reapproximates the tendon edges.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Meyer
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013536:Suture Techniques / Q000295:instrumentation*; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D058971:Tenotomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome