Management of Acute Midsubstance Patella Tendon Rupture

» Midsubstance patellar tendon repairs are rare, technically demanding surgeries that are distinct from proximal and distal avulsions due to the challenges of tendon-to-tendon healing and zone of injury tissue quality. » Primary repair using the Krackow suturing technique remains the most widely used method, often combined with patellar and tibial-based fixation. » Protective constructs such as high-strength suture configurations or cerclage wire are employed to share load with the repair site and support healing and function. » Structural and biological augmentations, including autografts, allografts, synthetic ligaments, and collagen scaffolds, are increasingly used to reinforce the injured extensor mechanism, support repair, and enhance healing, particularly in high-risk or complex patients. » Postoperative rehabilitation protocols vary but generally include a period of immobilization in extension followed by progressive flexion, isometric quadriceps activation, and return to normal activity at 9 to 12 months and return to a preinjury level at 12 to 18 months.