Reconstruction With Peroneus Longus Allograft for Chronic Subtotal Patellar Tendon Lesion: Surgical Technique and Clinical Implications

Chronic patellar tendon (PT) injuries lead to anterior knee pain and loss of active extension, often requiring reconstruction when direct repair is not feasible. We present a case of a 67-year-old patient with a history of poliomyelitis and a previous patellar fracture, who developed a chronic subtotal PT rupture that had been left untreated. Reconstruction was performed using a peroneus longus tendon allograft. After debridement of degenerated tissue, two converging patellar bone tunnels and one transverse tibial tunnel were created. The graft was whipstitched at both ends, passed through the tunnels, and fixed to the tibial tuberosity with non-absorbable suture anchors. At six months, the patient showed substantial improvement in range of motion (-5°-110°), extensor strength (0/5→3/5), and pain (VAS 7→4), along with better functional scores (KSS 45→65; Tegner 1→2-3). At 12 months, the reconstruction remained stable with further recovery. The peroneus longus allograft provided adequate strength, suitable dimensions, and no donor-site morbidity, representing a reliable option for chronic PT reconstruction in patients with poor local tissue quality or comorbidities.