Background <p>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.</p> Objective <p>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<sup>®</sup> fixation, thus minimizing graft wastage and fracture risk.</p> Methods <p>With the knee flexed at 90° and a thigh tourniquet, the ipsilateral ST is harvested through a medial incision, reinforced with FiberWire<sup>®</sup>-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&#xa0;mm laterally and medially and 7–8&#xa0;mm centrally, only in the proximal part, to accommodate the thickness of the graft. The rest of the quadriceps is reinforced with FiberWire<sup>®</sup>-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<sup>®</sup>. Krakow sutures for the native tendon and a FiberTape<sup>®</sup> 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<sup>®</sup>.</p> Conclusions <p>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.</p>

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

  • Pasquale Porcelli,
  • Kristijan Zoccola,
  • Simone Cambursano,
  • Riccardo Giai Via,
  • Fortunato Giustra,
  • Alessandro Massè,
  • Marcello Capella

摘要

Background

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.

Objective

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.

Methods

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®.

Conclusions

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.