1. Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion
David K. Galos, M.D., Sanjit R. Konda, M.D., Daniel J. Kaplan, B.A., William E. Ryan, B.S., Michael J. Alaia, M.D. 
Arthroscopy Techniques 
Volume 5, Issue 2, Pages e385-e389 (April 2016)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
In a patient with a ruptured patellar tendon, after a midline incision is made over the tendon, medial and lateral paratenon flaps are raised, allowing visualization of the avulsed patellar tendon. The patient is placed supine on a standard operating table with all bony prominences well padded.
Arthroscopy Techniques 2016 5, e385-e389DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
After identification and debridement of the tibial tuberosity footprint with a curette to obtain a bleeding bony surface, 2 double-loaded, 4.5-mm PEEK (polyether ether ketone) Corkscrew anchors are placed at the proximal extent of the footprint, 1 medially and 1 laterally. At least 1 cm of bone should bridge these anchors and be left between screws to avoid inadvertent fracture. The patient is placed supine on a standard operating table with all bony prominences well padded.
Arthroscopy Techniques 2016 5, e385-e389DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
Anterior aspect of the distal patellar tendon. A free suture strand from each of the 2 anchors (in the tibial tuberosity footprint) is passed once through the patellar tendon, from deep to superficial, just next to the exiting Krackow sutures. This suture is used to slide the Krackow sutures and reapproximate the avulsed tendon to the tibial tuberosity footprint. The other sutures from the set of double-loaded anchors are then used to place a single, inverted mattress suture approximately 3 mm distal to the Krackow suture in the patellar tendon to augment the repair.
Arthroscopy Techniques 2016 5, e385-e389DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Once the proximal extent of the ruptured patellar tendon is reapproximated to the footprint, the suture tails are passed through two 2.9-mm PEEK (polyether ether ketone) PushLock anchors in a box-type configuration similar to that used for a double-row, transosseous-equivalent rotator cuff repair. The sutures are then tied in standard fashion with the leg held in full extension. This secures the proximal portion of the patellar tendon repair.
Arthroscopy Techniques 2016 5, e385-e389DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
Final construct of the patellar tendon repair showing a reduced patellar tendon onto the tibial tubercle footprint with the knee in 90° of flexion. There is minimal stress on the repaired tendon with the described technique.
Arthroscopy Techniques 2016 5, e385-e389DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions