Acute Repair of Ruptured Patellar Tendon

Justin H. Bartley

Kristina L. Welton

Eric C. McCarty

Sterile Instruments/Equipment (Fig. 51-1)

• Tourniquet (optional—rarely used by authors)

• Skin retractors

• Scalpel (no. 10 or no. 15 blade)

• Dissection scissors

• Pickups

• Needle driver

• ACL tibial guide (optional)

• 2.5-mm drill

• Hewson suture passer

• Two no. 5 nonabsorbable, braided, high-tensile strength, polyfilament suture

• One to two no. 2 nonabsorbable, braided, polyfilament suture

• One no. 2 absorbable, monofilament suture

Figure 51-1 | Sterile instruments and equipment.

Positioning (Fig. 51-2)

• The patient is positioned supine on a regular operative bed, small bump beneath the hip such that the knee is point straight upwards, tourniquet in place on operative extremity—but not inflated unless deemed necessary, large sterile bump beneath the operative knee to allow ˜30 degrees of flexion during the surgery.

Figure 51-2 | Supine positioning of patient with extremity draping and sterile bump beneath knee.

Surgical Approach (Fig. 51-3)

• Midline incision is made from two fingerbreadths proximal to the patella, inferiorly to the midaspect of the tibial tubercle through subcutaneous fat to fascia.

• Medial and lateral flaps are developed to expose the entire patellar and ruptured patellar tendon and retinaculum.

Figure 51-3 | Midline surgical approach demonstrating disrupted patellar tendon, paratenon, and retinaculum.

• Typically the paratenon, medial and lateral patellar retinaculum, and the patellar tendon are completely disrupted.

• However, if the paratenon can be developed in a separate plane, then this should be performed so that closure can be done in layers at the end of the case.

• Any friable and nonviable tissue is debrided from the edges of the retinaculum and patellar tendon sharply with a fresh blade and/or small rongeur.

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