All-Soft Tissue Patellar Tendon Reconstruction With Onlay Fixation: A Technique for Midsubstance Tear

Patellar tendon rupture is a debilitating and relatively rare injury often managed with acute primary repair, with overall favorable clinical outcomes. However, while most tears occur near the insertion on the inferior pole of the patella, a smaller subset occur within the midsubstance of the tendon and may be irreparable by acute primary repair due to the location and soft tissue quality. No consensus exists on the preferred reconstruction technique in the acute setting, with a lack of data on postoperative outcomes. This Technical Note illustrates an approach to the reconstruction of an acute irreparable midsubstance patellar tendon tear utilizing an Achilles tendon allograft with onlay fixation. The highlights of this technique include an all-soft tissue reconstruction, double-row linked repair technique at the tibial tubercle insertion, transosseous tunnel fixation at the inferior pole of the patella, and incorporation of the excess allograft into native extensor mechanism tissue for additional soft tissue fixation to the patella.