Patellar Tendon Reconstruction With Achilles Allograft: A Technical Note

Patellar tendon ruptures are relatively common injuries, often caused by high tensile forces on a weakened tendon. In younger patients, they typically result from eccentric loading on the extensor mechanism, whereas in older patients, trauma is the more common cause. These injuries can be functionally limiting and challenging to treat when chronic due to tendon atrophy, scarring, and proximal retraction.

Reconstruction is indicated for patients with chronic, symptomatic patellar tendon ruptures confirmed by clinical and radiographic evaluation.

A longitudinal midline incision was made, and dissection proceeded through the subcutaneous tissue to identify the ruptured tendon. Fibrotic tissue was debrided, and the tendon length was adjusted to restore patellar height. Three 3.5-mm drill holes were created at the inferior pole of the patella for 5.5-mm bio-composite anchors. Sutures were placed in a Krackow interlocking fashion, with limbs tied in full extension. An Achilles tendon allograft with a bone block was prepared. A 10 × 20 mm tunnel was drilled distal to the tibial tubercle, and the graft was secured with a metal interference screw. The graft was looped proximally and secured to the native tendon with suture tape in a double-layer Krakow configuration. Additional anchors were placed at the tibial tubercle to secure the distal graft.

This technique demonstrated excellent functional outcomes, with radiographic evidence of a healed, well-fixed graft and restored patellar height. The patient achieved 120° of knee flexion, full extension, and independent ambulation at the 6-month follow-up.

Achilles allograft augmentation offers a reliable solution for chronic patellar tendon ruptures, especially in cases with tendon atrophy or retraction, eliminating donor site morbidity and enabling strong fixation and early rehabilitation.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.