1. Frontal Tendon Lengthening Plasty for Treatment of Structural Patella Baja 
Valentino F. Bruhin, M.D., Stefan Preiss, M.D., Gian M. Salzmann, M.D., Laurent P. Harder, M.D. 
Arthroscopy Techniques 
Volume 5, Issue 6, Pages e1395-e1400 (December 2016)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
Image of a right knee. The patient is placed in supine position with extended knee. After the meticulous central approach to the knee and mobilization of the patellar tendon (star), the tendon is split in the frontal plane to an equally thick anterior (superficial) and posterior (deep) layer using a No. 2 Fiberwire (FiberWire, Arthrex, Naples, FL) as a Gigli Saw (arrows). Such split is only feasible when enough tendon thickness is provided (10 mm on sagittal magnetic resonance imaging).
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Image of a right knee. The patient is placed in supine position with extended knee. After splitting the tendon in the frontal plane, the superficial layer (star) is detached from the tibial tubercle (star) as far distally as possible and the deep layer (circle) is detached from the patella (circle) as far proximally as possible to achieve the maximum possible tendon length. The lengthening of the patella tendon is the goal of this surgery.
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
Image of a right knee. The patient is placed in supine position with 90° flexed knee. The 2 layers are now overlapped and fixed at 90° flexion tendon to tendon with a minimal overlap of 5 mm. The yellow arrow shows the gained length.
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Image of a right knee. The patient is placed in supine position with 90° flexed knee. A 1-cm-wide and 10-cm-long strip of the superficial quadriceps tendon (star) is mobilized and detached subperiosteally at the patella. Then it is flipped and turned down to the patella where it is secured by 2 resorbable sutures (arrows).
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
Image of a right knee. The patient is placed in supine position with 90° flexed knee. The superficial quadriceps tendon strip (star) is now turned over to augment the patellar tendon. At the side the modified McLaughlin cerclage is visible (arrows) that secures the tendon plasty additionally.
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
Image of a right knee. The patient is placed in supine position with 90° flexed knee. The quadriceps tendon strip (stars) covers the patella tendon plasty and is fixed using resorbable sutures. The procedure is finished by suturation of the extraction point (arrows).
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

8. Fig 7
Radiographic image of the right knee preoperatively with an Insall-Salvati index of 0.45 and 1 year postoperatively with an Insall-Salvati index of 0.8.
Arthroscopy Techniques 2016 5, e1395-e1400DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions