Primary Repair of Chronic Quadriceps Tendon Rupture With Dermal Allograft Augmentation: Surgical Technique and Case Review.

BACKGROUND

Repair of chronic quadriceps tendon ruptures has high rates of rerupture and extensor lag. Dermal allograft augmentation of tendon repairs has shown to increase repair strength and healing rates.

INDICATIONS: We supplement primary quadriceps repair with dermal allograft augmentation in cases where tissue degeneration has occurred secondary to a subacute or chronic nature to help facilitate incorporation of the tendon tissue to bone.

TECHNIQUE DESCRIPTION: The patient is a 30-year-old man who presented with a chronic quadriceps tendon rupture. Intraoperatively, the quadriceps tendon excursion was found to be adequate for primary repair. Two sets of fiber tapes were used to secure the quad tendon with Krackow stitches and were loaded onto 2 suture anchors and placed in the proximal pole of the patella. The medial and lateral anchor sutures and loops were fed through the medial and lateral aspects of the dermal allograft, respectively. To secure the dermal allograft, the stay suture from the medial anchor was passed through the knotless mechanism of the lateral anchor and vice versa. This allowed for a broad area of direct compression of the allograft against the site of repair at the tendon bone interface between the 2 anchors.

RESULTS

Chronic quadriceps tendon repairs are known to have poor outcomes with up to 10% rerupture rates and extensor lag of more than 5° in 22% of cases. Several studies have shown that dermal allograft augmentation of tendon repairs increases pullout strength, maximum load to failure, and healing rates.

DISCUSSION/

CONCLUSION

Dermal allograft augmentations of chronic quadriceps rupture repair provide a scaffolding for cellular migration and collagen formation to help solidify the bone-tendon interface and may prove useful in addressing the reported high rates of rerupture and extensor lag.

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.