Autologous Semitendinosus Graft Augmentation in Patellar Tendon Re-Rupture Repair: A Case Report

Introduction: Patellar tendon ruptures can occur at every point of the tendon length, from patella’s inferior pole to the anterior tibial tubercle. Treatment of acute patellar tendon ruptures involves direct tendon-to-tendon repair or transosseous sutures, usually combined with an additional procedure to temporarily protect the repair. This article describes the use of semitendinosus graft in the treatment of a patellar tendon early re-rupture. Case Presentation: A 69-year-old male patient suffering a complete traumatic rupture of the patellar tendon was operated with direct end-to-end tendon suture using the Kessler technique and augmentation with PDS Cord. Twenty days after surgery, he suffered a further knee injury with recurrence of tendon rupture at the same height of primary rupture. In the second surgery, the previous suture was removed and the tendon stumps were debrided. Two sutures with Krackow technique were performed using FiberWire in both the proximal and distal stump. Semitendinosus tendon was harvested. Two transosseous tunnels were drilled at the middle third of the patella and of the anterior tibial tuberosity. The semitendinosus graft was inserted transversely through the tunnel into the tibial tuberosity. Correct patella height was reached using the contralateral patella as a reference. Then, the two tails of the graft were sutured together. For the first 2 weeks post-operatively, the knee was immobilized in an extension brace, with a full weight bearing allowed. Subsequently, an articulated brace was placed with progressively increasing flexion angles (30° increase every 2 weeks). The patient continued physical therapy for a total of 5 months. At the last follow-up visit (24 weeks post-operatively), the patient was pain free and had returned to work. Knee range of motion was complete and comparable to the contralateral knee.