Table 3.

Pearls and Pitfalls of Patellar Tendon Repair Using Semitendinosus Autograft Augmentation and Bidirectional Fixation

Pearls

Careful central positioning of the TightRope drill will allow 1-cm osseous bridges to be maintained between the medial and lateral tunnels.

If normal patellar height is not readily evident, a radiograph of the contralateral knee should be obtained as a reference.

The TightRope device should be directly visualized after it has been flipped over the proximal pole of the patella.

The final construct should be tested intraoperatively to assess the repair tension and confirm that the knee can be safely ranged during early mobilization.

Pitfalls

Failure to ensure an adequate distance between the transosseous tunnels may result in either tunnel coalition or an inability to use suture anchors in the distal pole of the patella.

Over-reduction of the patellar tendon with the initial transosseous sutures may lead to patella baja.

If the TightRope device flips within the quadriceps tendon, it can initially feel secure and later subside, resulting in gap formation.