Quadriceps Tendon Repair Failed Fixation

Quadriceps tendon (QT) ruptures are relatively uncommon injuries that, if not managed appropriately, have the potential to cause significant disability. When surgical repair of the tendon is performed acutely (within 2–3 weeks of injury), most patients will return to pre-injury activity levels. Several surgical repair techniques exist, with the most common and well-studied being transosseous (TO) tunnel drilling with suture fixation or suture anchor (SA) fixation. When treating a chronic quadriceps rupture or failed primary repair, substantial scarring is common, often associated with tendon retraction. Subsequent repairs necessitate additional surgical techniques to overcome this, including tendon lengthening and/or allograft augmented reconstruction. However, given that failed repairs and chronic QT ruptures are uncommon, there are only small studies to inform optimal surgical management. The following chapter illustrates the successful repair of a failed repair of the quadriceps tendon, including a detailed step-by-step guide on performing the revision reconstruction technique. Case: A 41-year-old male with a history of a right quadriceps tendon rupture status post repair, presented with a failed repair complicated by tendon retraction and physical disability. In this case, an Achilles allograft with an accompanying bone block was chosen to augment the repair. Because the patellar tendon was retracted distally, a Z-plasty technique was necessary to restore the appropriate length. Lengthening of the quadriceps tendon was also necessary to allow for more excursion prior to the repair. A residual graft from the donor Achilles tendon was used as augmentation to reinforce the quad tendon repair. Final follow-up images, along with intraoperative photos, are presented to document this complex revision case.