• Beath pin

• No. 5 braided polyester suture

• Power wire driver/drill

• Allis clamps ×2

• Senn retractors ×2

• Army-Navy retractors ×2

• Periosteal elevator

• Metzenbaum scissors

• Rongeur

• The patient is positioned supine on the operating room table.

• A sterile bump is used to put slight tension on the extensor mechanism. This is especially helpful during the surgical approach.

• A tourniquet is placed on the thigh but not inflated unless necessary.

• A direct midline approach to the quadriceps tendon and patella is used, centered over the rupture site, which usually is at its attachment to the proximal pole of the patella.

• The knee is slightly flexed over a sterile bump.

• The skin incision over the quadriceps tendon and patella is 10 cm long.

• The skin and subcutaneous fat are incised sharply down to the level of the extensor mechanism.

• Medial and lateral skin flaps are elevated to expose the quadriceps tendon and the medial and lateral retinacula. Metzenbaum scissors and a periosteal elevator covered with a sponge also are used to mobilize the quadriceps tendon.

• Two Allis clamps are placed on the distal quadriceps tendon and pulled to the level of the superior pole of the patella as the knee is extended.

• A small rongeur is used to debride and roughen the attachment of the quadriceps tendon on the superior patella down to bleeding bone (Fig. 52-1). The distal end of the ruptured quadriceps tendon is sharply debrided of degenerative tendon.

• A 4-strand repair using running locked suture technique similar to that described by Krackow et al.¹ is performed with no. 5 braided polyester suture, tensioning the suture with each passage (Fig. 52-2).