Surgical Technique: Repair of Patella Tendon Rupture in a Previously Harvested Tendon for an Anterior Cruciate Ligament Reconstruction

BACKGROUND: A rare cause of patellar tendon (PT) ruptures is complications after bone-PT-bone (BPTB) graft harvest for anterior cruciate ligament (ACL) reconstruction. The atypical tear pattern in these patients can be technically challenging to address. DESCRIPTION OF TECHNIQUE: A Krackow suture fixation of the medial, tibial based PT was fixed with a knotless suture anchor to the patella. A Krackow suture fixation of the lateral, patella based PT was fixed with a knotless suture anchor to the tibia. Fiber Tape was used for an Internal Brace. PATIENT AND METHODS: We retrospectively reviewed a single patient with a proximal-medial and distal-lateral PT rupture following BPTB graft harvest for an ACL reconstruction. The described repair technique was used to repair the PT rupture. Follow-up was 6-months. Range of motion (ROM), functional outcome scores, and patient-reported outcomes were assessed and recorded. RESULTS: Six-months postoperatively, the patient has regained full knee extension and flexion to 130 degrees. The patient has good quadriceps strength, and manual muscle testing shows no deficits in the operative leg. The patient is able to perform all of her activities of daily living and is discharged from physical therapy. CONCLUSION: We describe a novel technique that effectively repairs the atypical PT rupture pattern seen after ACL reconstruction using BPTB autograft. This technique allows for aggressive post-operative rehabilitation in ROM and strengthening. LEVEL OF EVIDENCE: Level V.