Patellar tendon tears are rare, accounting for 3% of all knee injuries. Typically, acute, isolated patellar tendon tears are amenable to direct, end-to-end repair within 1 to 2 weeks postinjury. However, direct repair is not a viable option and is associated with poor outcomes in certain patients, such as patients with chronic tears, patients with a tendinopathy-associated tear, patients with a degenerative tear, patients who undergo revision repair, and patients with extensive soft-tissue defects and a patellar fracture/nonunion. In these patients, successful patellar tendon reconstruction has been described via tissue augmentation with the use of various grafts and techniques. In general, patients regain extensor function without clinical evidence of a lag.

This video demonstrates the technique for patellar tendon reconstruction via quadriceps V-Y advancement plasty with the use of an Achilles tendon soft-tissue allograft and the technique for patellar tendon reconstruction via quadriceps V-Y advancement plasty with the use of a hamstring tendon autograft and Achilles tendinous bone plug allograft.

The video provides an overview on the anatomy and pathogenesis of patellar tendon ruptures and discusses treatment options and techniques for patellar tendon reconstruction. The video discusses the case presentation of a 33-year-old man (first patient) with bilateral knee pain (left knee pain greater than right knee pain) who sustained a fall 2 years ago. The patient has a history of renal osteodystrophy. The video discusses the case presentation of a 56-year-old man (second patient) with left knee pain who underwent left patellar tendon repair 6 years ago and surgical fixation of the left tibial plateau 3 years ago. Preoperatively, the first patient was unable to perform the straight leg raise test, and the second patient had an extensor lag of 30°. In both patients, radiographs revealed patella alta, and advanced imaging studies revealed discontinuity of the patellar tendon. Both patients underwent patellar tendon reconstruction.

The patients were discharged on the day of surgery. Patients were instructed to use crutches and a hinged knee brace locked in extension and to remain partial weight bearing. Range of motion and weight-bearing were gradually advanced over the course of 12 weeks. The hinged knee brace was discontinued 6 weeks postoperatively, and the crutches were discontinued 12 weeks postoperatively. Physical therapy was individualized for each patient. Both patients were able to perform the straight leg raise test without difficulty 8 months postoperatively, which was a substantial improvement.

Patellar tendon reconstruction is a versatile and reliable treatment option for patients with a patellar tendon rupture who are not appropriate candidates for direct repair or in whom direct repair fails. Although the literature on patellar tendon reconstruction is limited, multiple case series have demonstrated adequate to excellent clinical results and patient-reported outcomes.