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Quadriceps Tendon Rupture
Updated: Oct 9 2017

Quadriceps Tendon Rupture Repair

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Preoperative Plan

  • Assess location of extensor mechanism injury
  • Use physical exam, xray, and MRI if available
  • MRI is rarely needed


Execute surgical walktrough

  • describe key steps of procedure verbally prior to the start of the case


Description of potential complications and steps to avoid them


Room Preparation


Room setup and Equipment

  • standard OR table


Patient Positioning

  • supine position
  • place bump on the ipsilateral hip
  • place tourniquet high on the thigh
  • have an assistant milk the quad tendon distal prior to placing the tourniquet.

Medial Parapatellar Approach


Mark and make midline incision

  • The incision will need to allow access to the injured quadriceps tendon and the inferior pole of the patella. A tourniquet may be inflated prior to incision. One single incision can be made extending from the inferior pole of the patella to the ruptured portion of the quadriceps tendon.
  • Make the incision

Deep Dissection


Dissect through subcutaneous tissue

  • Dissect through subcutaneous tissue
  • Carry the incision through the subcutaneous tissue until the quadriceps tendon rupture and the patella are identified
  • Evacuate the hematoma and irrigate the joint.

Prepare Tendon


Remove all nonviable tissue

  • debride tissue as needed
  • disrupt all adhesions that are present


Place sutures

  • place two number 5 nonabsorbable sutures using a krackow stitch through the full thickness medial and lateral aspects of the tendon
  • four strands of sutures should exit from the distal portion of the quadriceps tendon (2 medial and 2 lateral)

Prepare the Patella


Expose cancellous bone

  • debride the superior pole of the patella of any remaining tendon
  • use a curet, rongeur or burr to expose cancellous bleeding bone


Create bone tunnels

  • use a 2.5 mm drill to create medial, middle and lateral longitudinal holes through the patella

Reattach Tendon


Pass sutures

  • use a suture passer to pull the four suture limbs through the bone tunnels
  • the two middle sutures (one from medial limb and one from lateral limb)will be passed through the middle patella drill hole.
  • the most lateral suture will pass through the lateral drill hole.
  • the most medial suture will pass through the medial drill hole.


Secure the sutures

  • place the knee in full extension.
  • tie the most medial suture to the medial limb of the central two sutures.
  • tie the most lateral suture to the lateral limb of the central two sutures.

Repair Retinaculum


Inspect and repair retinaculum

  • identify and repair tears in the medial and lateral retinaculum

Wound Closure


Irrigation, hemostasis, and drain

  • copiously irrigate the wound


Deep closure

  • close the deep fascia with 0 interrupted absorbable suture


superficial closure

  • close the superficial subcutaneous tissue with 2-0 absorbable suture
  • skin can be closed with absorbable or nonabsorbable sutures.


dressing and immediate immobilization

  • place sterile dressing over incision
  • place in a hinged knee brace locked in extension
Postoperative Patient Care
Private Note

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