Semitendinosus Autograft Reconstruction for Neglected Patellar Tendon Rupture: Technical Simplicity with Excellent Outcome

Introduction: Patellar tendon rupture is an uncommon but disabling injury, often resulting from eccentric quadriceps contraction or trauma. Chronic ruptures (>3 weeks) present a reconstructive challenge due to patellar migration, scarring, and tendon retraction, making primary repair inadequate. Various graft options exist; autologous semitendinosus provides a strong, biologically compatible solution with minimal morbidity. Case Report: A 42-year-old man presented 8 weeks post-injury with left knee instability and inability to extend the leg following a fall. Examination revealed patella alta and an extensor lag. Radiographs and magnetic resonance imaging confirmed chronic patellar tendon rupture with retraction and fibrosis. Surgical reconstruction was performed using an ipsilateral semitendinosus autograft. After adhesiolysis and distal mobilization of the patella, transosseous tunnels were created in the patella and proximal tibia. The semitendinosus graft was passed in a figure-of-eight fashion to recreate the patellar tendon and secured with Suture Tape augmentation. The knee was immobilized in extension initially, with early passive motion and progressive flexion from week 3 onward. Active mobilization and strengthening were started after 6 weeks, and the brace was discontinued by 10-12 weeks. At 6 months, the patient achieved full active extension, 0-120° knee motion, 5/5 quadriceps strength, normal patellar height, and a pain-free gait without lag or instability. Conclusion: Chronic patellar tendon ruptures can be successfully reconstructed using a semitendinosus autograft with transosseous fixation and suture augmentation. This technique restores extensor mechanism continuity and yields excellent functional recovery when combined with meticulous soft-tissue release and structured rehabilitation.