Achilles Allograft Reconstruction With V-Y Quadriceps Advancement for Chronic Patellar Tendon Insufficiency

Background: Chronic patellar tendon insufficiency often results in loss of active knee extension, retraction of the quadriceps, and patella alta. This study outlines a surgical technique for patellar tendon reconstruction using an Achilles allograft with V-Y quadriceps advancement, in the context of failed prior mid-substance patellar tendon repair. Indications: Reconstruction is indicated in patients with complete tears of the patellar tendon that are non-amenable to primary repair. Other considerations include failed prior repair or persistent functional deficits in patients with contributing patellar tendon insufficiency. V-Y quadriceps advancement may be implemented if there are concerns for quadriceps retraction, patella alta, and inability to achieve tension-free reconstruction. Technique Description: The V-Y quadricepsplasty was performed initially to deliver the patella inferiorly before inferior pole suture anchors were placed. The patellar tendon reconstruction consisted of an Achilles allograft with calcaneal bone block fixation at the tibial tuberosity, augmented with distal suture fixation. Medial retinacular repair via ipsilateral hamstring autograft was incorporated into the overall construct, which was fixated at the inferior patellar pole anchors and soft tissues superiorly. Results: At 2 weeks postoperatively, the patient is progressing well, without complications, and the stability of the construct is maintained. Recovery of range of motion and return to full function may be expected in approximately 9 to 12 months. Discussion/Conclusion: This study describes a patellar tendon reconstruction using an Achilles allograft and a V-Y quadriceps advancement, with concomitant medial retinacular repair, for chronic patellar insufficiency and patella alta in a 35-year-old man. The literature supports similar outcomes for several graft options and techniques to address patellar tendon reconstruction. However, the use of Achilles allograft may be superior in terms of patient-reported pain measures. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.