A method of repair of late quadriceps rupture

Delayed treatment of a quadriceps rupture is an infrequent but difficult situation. The fibrous degeneration and muscle retraction and subsequent hiatus present a challenging technical problem. A 54-year-old laborer with a 7-week quadriceps rupture was treated by a method that seems not to have been previously reported. At surgery there was a 9-cm gap that could not be approximated by either a Bunnell suture, or Codvilla lengthening of Scuderi inverted triangle. Repair was successfully accomplished by transposing the inner one-third of the patellar tendon. The tendon was split longitudinally and separated from the medial and lateral aspects in a distal to proximal direction with an osteoperiosteal flap. This was proximally sutured across the gap in the quadriceps mechanism. Eighteen months postoperatively there was no extension lag with knee range of motion of 0 degrees-125 degrees and good power.