{
    "abstract": "Whereas partial quadriceps tendon ruptures may be treated nonoperatively if the extensor mechanism remains functional, complete ruptures require primary operative repair to achieve optimal functional results\nThe patient is positioned supine with the injured leg exposed. A midline incision to the knee is made over the quadriceps tendon defect, exposing the distal quadriceps and proximal patella. Irrigation is utilized to evacuate the residual hematoma, and the distal quadriceps and proximal patella are debrided of degenerative tissue. When utilizing transosseous tunnels, a nonabsorbable suture is passed full-thickness through the medial or lateral half of the quadriceps tendon in a locked, running pattern (i.e., Krackow). A second nonabsorbable suture is passed full-thickness through the other half of the tendon. There should then be 4 loose strands at the distal quadriceps. The anatomic insertion of the quadriceps tendon is roughened with a sharp curet to expose fresh cancellous bone. Three parallel bone tunnels are created along the longitudinal axis of the patella. The knee is placed in full extension, with a bump under the heel in order to provide slight recurvatum at the knee and to allow for a properly tensioned repair. In pairs, the free ends of the sutures are passed through the tunnels. The sutures are tensioned and tied together in pairs at the distal aspect of the patella. Alternatively, when utilizing suture anchors, Arthrex FiberTape is passed full-thickness through the medial or lateral half of the quadriceps tendon in a Krackow pattern. A second FiberTape is passed full-thickness through the other half of the tendon. There should then be 4 loose tails at the distal quadriceps. The 2 tails of the medial FiberTape are placed into a knotless Arthrex SwiveLock anchor; this step is repeated for the 2 lateral tails. The anatomic insertion of the quadriceps tendon is roughened to expose fresh cancellous bone. With use of a 3.5-mm drill, create 2 parallel drill holes along the longitudinal axis of the patella, with sufficient depth to bury the SwiveLock anchor. Unlike in the transosseous tunnel technique, these drill holes do not run the length of the patella. The holes are then tapped. Following irrigation, the anchors are tensioned into the bone tunnels, and extra tape is cut flush to the bone. For both techniques, additional tears in the medial and lateral retinacula are repaired if present.\nAlternatives include nonoperative treatment with use of a hinged knee brace; operative treatment with use of simple sutures; and augmentation with use of wire reinforcement, cancellous screws, the Scuderi technique, the Codivilla technique, tensor fasciae latae reinforcement, and/or MERSILENE tape (Ethicon).\nPrimary operative repair of quadriceps tendon ruptures is a well-documented, successful procedure with biomechanical, clinical, and patient-reported data to support its use\nPrimary repair of quadriceps tendon ruptures, utilizing either the transosseous tunnel or suture anchor technique, yields excellent outcomes. Following surgical treatment, patients have near-full recovery in range of motion, with studies reporting a <5\u00b0 deficit compared with the contralateral, uninjured limb\nWhen performing the Krackow stitch, be sure to tension and remove all slack before performing another tissue pass.Surgical repair should be performed as soon as possible from the time of injury in order to minimize risks and to achieve optimal surgical outcomes.If there is concern that the primary construct would be unstable, it can be augmented with wire reinforcement, cancellous screws, the Scuderi technique, the Codivilla technique, tensor fasciae latae reinforcement, and/or MERSILENE tape.Identify and repair patellar retinaculum tears, which are common concomitant injuries in the setting of complete quadriceps rupture.\nMRI = magnetic resonance imaging.",
    "authors": [
        {
            "affiliation": "Department of Orthopaedics, University of Utah, Salt Lake City, Utah.",
            "firstname": "Tyler J",
            "initials": "TJ",
            "lastname": "Thorne"
        },
        {
            "affiliation": "Department of Orthopaedics, University of Utah, Salt Lake City, Utah.",
            "firstname": "Willie",
            "initials": "W",
            "lastname": "Dong"
        },
        {
            "affiliation": "Department of Orthopaedics, University of Utah, Salt Lake City, Utah.",
            "firstname": "Thomas F",
            "initials": "TF",
            "lastname": "Higgins"
        },
        {
            "affiliation": "Department of Orthopaedics, University of Utah, Salt Lake City, Utah.",
            "firstname": "David L",
            "initials": "DL",
            "lastname": "Rothberg"
        },
        {
            "affiliation": "Department of Orthopaedics, University of Utah, Salt Lake City, Utah.",
            "firstname": "Justin M",
            "initials": "JM",
            "lastname": "Haller"
        },
        {
            "affiliation": "Department of Orthopaedics, University of Utah, Salt Lake City, Utah.",
            "firstname": "Lucas S",
            "initials": "LS",
            "lastname": "Marchand"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2024 by The Journal of Bone and Joint Surgery, Incorporated.",
    "doi": "10.2106/JBJS.ST.23.00045",
    "journal": "JBJS essential surgical techniques",
    "keywords": [],
    "methods": null,
    "publication_date": "2024-09-24",
    "pubmed_id": "39314211\n35130193\n12828449\n24529850\n22959496\n9619463\n3780084\n8472417\n16685096\n17621001\n33041016\n12084643\n6985557\n23409573",
    "results": null,
    "title": "Primary Repair of Complete Quadriceps Tendon Rupture with Extensor Mechanism Deficit.",
    "xml": "<Element 'PubmedArticle' at 0x788504379710>"
}