Bilateral multipartite patellae avulsions associated with a unilateral quadriceps tendon rupture

Multipartite (or bipartite) patella is a developmental anomaly that occurs in 2%–6% of individuals. In 50%, the variant is bilateral. Multipartite patella is usually an asymptomatic condition. Quadriceps tendon rupture is also a rare entity occurring mostly in men aged >40 years and usually results from an acute eccentric quadriceps contracture. The authors present a case of a patient with bilateral multipartite patellae that sustained bilateral multipartite avulsions as well as an associated unilateral quadriceps tendon rupture. This constellation of injuries has never been reported in the literature. The patient was treated with excision of the multipartite patella fragments and quadriceps tendon repair on the side with the extensor mechanism disruption. He was treated non-operatively for the contralateral lower extremity multipartite patella avulsion. This report, along with a thorough review of the literature, serves to demonstrate the clinical and radiographic characteristics of this unusual injury.

Easy and safe repair of quadriceps tendon rupture through transosseous sutures: A technical note

Many repair techniques have been used for quadriceps tendon rupture. Transosseous sutures are the golden standard since they can offer the safest and most stable tendon reattachment. Drilling in parallel to the patella’s longitudinal axis while avoiding the articular surface can be particularly challenging. In addition, drilling the patella has been shown to increase the possibility of an intraoperative fracture, especially if large diameter drills are being used. The present technical note demonstrates a simple, safe, cost-effective, and reproducible technique for quadriceps tendon repair. This technique is based on the use of a cruciate ligament reconstruction tibial tip aimer and guide wires with eyelet. After the accurate patella, entry and exit points for transosseous suturing are defined, the eyelet guide wires enable the passing of the sutures through the patella. Finally, the free ends of each suture are pulled and secured distally. This technique allows efficient and proper tendon fixation while minimizing potential complications.