Introduction: Although uncommon, chronic patellar tendon rupture and failure of primary repair can be challenging to treat and compromise the knee extensor mechanism. When tendon quality is poor and there is quadriceps contracture or fibrosis, repair may be limited, making patellar tendon reconstruction the preferred treatment approach. However, no unified view exists on the optimal graft selection for reconstruction of the patellar tendon. Case Series: This is a case series of five patients treated in a tertiary care facility between 2022 and 2025 for chronic or failed primary patellar tendon ruptures. In all five patients, reconstruction was performed using the ipsilateral hamstring or peroneal autografts. The harvested tendon was passed in a figure-of-eight fashion through trans-osseous tunnels created on the patella and the tibial tuberosity. The graft was then fixed to the tibia with bioabsorbable screws and suture anchors. Functional outcomes were evaluated at the final follow-up of 6 months, focusing on the range of motion, extensor lag, radiographic patellar height, and complications observed post-surgery. Results: At final follow-up, four out of five patients gained full active knee extension without any extensor lag, while one patient still had an extension lag of 20°. The range of knee flexion was 100-130°. No cases of re-rupture or fixation failure were observed. There was minimal donor-site morbidity, and no significant ankle instability was noted in patients who underwent peroneus longus tendon harvest. Conclusion: Patellar tendon reconstruction using autografts provides reliable restoration of knee extensor function in chronic ruptures and failed primary repairs. Both hamstring and peroneus longus tendons are effective graft options, and graft selection should be individualized based on tendon defect size, tissue quality, and intraoperative findings. Accurate restoration of patellar height is critical for optimal functional outcomes.
Patra et al. (Thu,) studied this question.