Patellar Tendon Repair With Gracilis Autograft Augmentation and Anchor Fixation

Patellar tendon rupture is a severe injury that disrupts knee extensor continuity and requires prompt surgical management. Although primary repair remains the standard treatment, isolated suture repair may be insufficient in cases of poor tissue quality or high mechanical demand, making augmentation necessary. Autologous hamstring grafts provide reliable biological reinforcement, and the gracilis tendon offers favorable handling characteristics, adequate tensile strength when doubled, and low donor-site morbidity. Hamstring grafts also show higher load-to-failure values than the native tendon, supporting their use to enhance initial construct stability. This Technical Note describes a reproducible technique for patellar tendon repair augmented with a doubled gracilis autograft, using suture-anchor fixation exclusively, without the need for patellar transosseous tunnels. The graft is positioned along the medial and lateral borders of the tendon to reinforce the primary repair while preserving patellar integrity. This approach offers a mechanically robust and biologically supported construct, providing an alternative to traditional methods in cases where additional reinforcement is warranted.