We performed quadriceps tendon reconstruction using ipsilateral autologous semitendinosus graft. The proximal part of the graft was fixed to the remnant of quadriceps tendon using the 5-0 Ethibond with Krackow suture technique. The distal part of the graft was fixed to the patella using double 5.5 mm metal suture anchors at the superior pole of patella. The postoperative Xray is shown in Figure 4. Postoperatively, the patient was immobilized in backslab with his left knee in fully extended position. After 3 weeks the patient was sent for physiotherapy to regain his left knee’s range of motion. At final follow up at six months, patient was able to walk with bipedal unassisted normal gait. Active knee extension and straight leg raising was possible. Final knee range of motion was from 0° to 130°

DISCUSSION  :

The injury known as ”chronic extensor mechanism quadriceps tendon rupture” is a severe condition that typically occurs when the rupture is not diagnosed in a timely manner, either owing to misdiagnosis or the incomplete rupture progressing to a complete rupture and seeking medical assistance at a later stage. Chronic rupture of a muscle will cause the muscle to contract, resulting in an expansion gap. The muscle body in this area becomes scarred, and the gap cannot be reduced. In addition, the quadriceps muscle experiences atrophy, leading to weakened quadriceps even after undergoing repair. This weakness, along with arthrofibrosis and residual stiffness, hinders the ability to attain the whole range of motion. In this patient, we used semitendinosus muscle in the specific situation of Quadriceps Tendon Rupture (QTR). The patient was reported to be free of any significant complaints. Various surgical methods can be employed to treat acute quadriceps tendon ruptures, including transosseous patellar tunnels, end-to-end sutures, anchor fixation, and graft augmentation. For cases of chronic quadriceps tendon rupture with tissue loss, it is advisable to utilise an autologous graft for the purpose of repairing and restoring the structure and function of the quadriceps tendon. McCormick and al [2] performed a surgical intervention utilising autografts from the patient’s semitendinosus and gracilis tendons to repair and substitute injured tendons in instances of chronic quadriceps tendon rupture. The hamstring tendon transplant was threaded through the quadriceps tendon (QT) and went through three patellar tunnels, which were created by piercing the bone. Afterwards, the graft was secured and attached to the distal end of the patella. The semitendinosus graft is an autograft commonly employed in surgical procedures for anterior cruciate ligament (ACL) replacement. The semitendinosus tendon, in conjunction with the gracilis tendon, is extracted from the patient’s own hamstring muscles and employed as a transplant to substitute the damaged ACL [3]. The semitendinosus tendon is folded to form a 4-stranded graft, resulting in a rigid biomechanical structure that is stiffer than other grafts including the patellar tendon, quadriceps tendon, and Achilles tendon grafts. A study has shown the restoration of the mechanical characteristics of the hamstring tendons following ACL surgery using a semitendinosus tendon autograft. Quadriceps tendon rupture that is not treated promptly can result in unfavourable outcomes, such as decreased functional outcomes, worse satisfaction levels, and reduced isokinetic data in patients who have delayed repair [4]. Postponing the surgical procedure can result in tendon shortening, scar tissue formation, and reduced blood circulation, ultimately leading to an unfavourable outcome.