This 1981 retrospective series of 67 patients with 72 extensor mechanism ruptures is the foundational comparative study on quadriceps tendon and patellar ligament injuries. It directly compares outcomes of immediate versus delayed repair and describes the pins-and-wires technique for neglected patellar ligament ruptures with severe quadriceps contracture.
Any patient after knee trauma who cannot actively extend or hold the leg straight against gravity has an extensor mechanism rupture until proven otherwise — do not let hemarthrosis or a normal-appearing radiograph reassure you.
The lateral radiograph is your fastest diagnostic tool: Patella alta (proximally displaced) → patellar ligament rupture Patella baja (distally displaced) → quadriceps tendon rupture
Once diagnosed, timing determines outcome more than technique. Immediate quadriceps tendon repair needs only end-to-end suture with 6-8 weeks immobilization. No external fixation required. Immediate patellar ligament repair always needs supplemental external fixation.
If the diagnosis has been missed for more than 2 weeks and the patella cannot be displaced distally by hand, do not attempt direct repair without first applying preoperative patellar traction. The pins-and-wires technique. Steinmann pin through the patella, max 2.3 kg traction for 4 days to 2 weeks, then figure-of-eight fascia lata graft reinforcement at repair. Is the established salvage strategy for this scenario.
This 1981 retrospective series of 67 patients with 72 extensor mechanism ruptures is the foundational comparative study on quadriceps tendon and patellar ligament injuries. It directly compares outcomes of immediate versus delayed repair and describes the pins-and-wires technique for neglected patellar ligament ruptures with severe quadriceps contracture.
Any patient after knee trauma who cannot actively extend or hold the leg straight against gravity has an extensor mechanism rupture until proven otherwise — do not let hemarthrosis or a normal-appearing radiograph reassure you.
The lateral radiograph is your fastest diagnostic tool: Patella alta (proximally displaced) → patellar ligament rupture Patella baja (distally displaced) → quadriceps tendon rupture
Once diagnosed, timing determines outcome more than technique. Immediate quadriceps tendon repair needs only end-to-end suture with 6-8 weeks immobilization. No external fixation required. Immediate patellar ligament repair always needs supplemental external fixation.
If the diagnosis has been missed for more than 2 weeks and the patella cannot be displaced distally by hand, do not attempt direct repair without first applying preoperative patellar traction. The pins-and-wires technique. Steinmann pin through the patella, max 2.3 kg traction for 4 days to 2 weeks, then figure-of-eight fascia lata graft reinforcement at repair. Is the established salvage strategy for this scenario.