Patellar socket technique for chronic quadriceps tendon repair: maximizing graft efficiency

Chronic quadriceps tendon ruptures (CQTR) result in tendon retraction, fibrosis and tissue loss, often precluding direct repair. Traditional transosseous techniques require large length grafts and full-thickness patellar tunnels, increasing the risk of fractures.

To present and evaluate a new surgical technique for reconstruction of CQTRs using an ipsilateral semitendinosus (ST) autograft fixed through a proximal patellar socket and Endobutton^® fixation, thus minimizing graft wastage and fracture risk.

With the knee flexed at 90° and a thigh tourniquet, the ipsilateral ST is harvested through a medial incision, reinforced with FiberWire^®-2 sutures, doubled and measured diametrically. A midline anterior approach exposed the chronic tendon defect, which must be debrided to the healthy margins. Three cavities are created in the proximal patella with an incannulated drill, each 5 mm laterally and medially and 7-8 mm centrally, only in the proximal part, to accommodate the thickness of the graft. The rest of the quadriceps is reinforced with FiberWire^®-5 Krakow sutures. Using transport sutures, the prepared ST graft is inserted into the tendon via a Pulvertaft weft, inserted into the central cavity, stretched and secured over the distal patellar cortex with an Endobutton^®. Krakow sutures for the native tendon and a FiberTape^® loop around the loop of the graft are passed through the respective tunnels and tied over the anterior patella. Intraoperative flexion confirms the stability of the construct; fluoroscopy verifies the height of the patella and the position of the Endobutton^®.

This proximal socket technique minimises the use of grafts and patellar stress, reliably restoring extensor mechanism function in CQTRs, offering a safe alternative to full transosseous tunnel methods.