Surgical Management of Acute Patellar Tendon Rupture

Patellar tendon ruptures typically require surgical repair. Acute injuries should be treated with primary tendon-to-bone or tendon-to-tendon repair followed by an accelerated rehabilitation program. Current repair techniques and materials usually allow for biomechanically robust repairs without the need for augmentation. In the event of poor tissue quality or delayed presentation, cerclage suture augmentation is appropriate for insertional ruptures and avoids the need for the later removal of wire. Midsubstance ruptures can be augmented with hamstring autograft or dermal matrix allograft. Dermal matrix allograft allows for circumferential biologic and biomechanical support for the repair and avoids the morbidity of tendon harvest and tunnel placement. After an augmented repair, an aggressive rehabilitation program should be followed in most cases, emphasizing full weight bearing in extension and an early range of motion in a hinged knee brace.