Quadriceps Tendon Rupture Repair

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Preoperative Plan

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

2

Execute surgical walktrough

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

3

Description of potential complications and steps to avoid them

F

Room Preparation

1

Room setup and Equipment

  • standard OR table

2

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.
G

Medial Parapatellar Approach

1

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
H

Deep Dissection

1

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.
I

Prepare Tendon

1

Remove all nonviable tissue

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

2

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)
J

Prepare the Patella

1

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

2

Create bone tunnels

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

Reattach Tendon

1

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.

2

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.
L

Repair Retinaculum

1

Inspect and repair retinaculum

  • identify and repair tears in the medial and lateral retinaculum
N

Wound Closure

1

Irrigation, hemostasis, and drain

  • copiously irrigate the wound

2

Deep closure

  • close the deep fascia with 0 interrupted absorbable suture

3

superficial closure

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

4

dressing and immediate immobilization

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

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