Neglected patella nonunion repair with tension band plating, quadricepsplasty, and tibial autograft

Nonunion of a displaced patellar fracture results in an elongated, incompetent extensor mechanism. Surgical repair must address loss of mobility of the extensor mechanism tendon and muscular components, bone resorption, impaired fracture biology, a wide fracture gap, and distracting forces across the nonunion site. A novel patellar nonunion fixation technique for the treatment of chronic patella nonunion is described including medial parapatellar arthrotomy, anterior interval release, open lysis of intra-articular adhesions, lateral capsular release, modified quadricepsplasty, tension band plating, autograft bone harvested from the proximal tibia, and quadriceps tendon advancement. Five patients treated with this technique achieved both clinical and radiographic union within 3 months and a mean active knee flexion of 98 degrees (range 45-140 degrees) with independent ambulation and without complication at 1-year follow-up.