OPERATION IN DETAIL: The patient was brought to the operating room and laid supine on the OR table. General anesthesia was induced. Right lower extremity was prepped and draped in the usual sterile fashion, after tourniquet was placed high on his right thigh. An Esmarch bandage was used to exsanguinate and tourniquet was inflated to 200 mmHg. Next, a standard anterior approach to the knee joint was performed. The patellar tendon rupture was identified. The tendon was debrided and freshened up using 11 blade. Next, a #5 Ti-Cron suture was passed using Krackow-type suture. Two #5 Ti-Cron sutures were passed to the patellar tendon and brought out through the tendon end. Next, a Beath needle was used to make three drill holes from distal to proximal in the patella. Next, the suture ends were brought out through the drill holes at the proximal end of the patella. Next, an 18-gauge wire was passed through the quadriceps tendon just superior to the superior pole of the patella. The drill hole was made from the medial to lateral and the tibial tubercle. The 18-gauge wire was passed through this drill hole and the knee was placed into hyperextension and the 18-gauge wire was then tightened. As the 18-gauge wire was tightened, the Ti-Cron sutures were securely tied at the superior pole of the patella and buried underneath the quadriceps tendon. Next, the final clamping of the wire was performed. Excellent repair was obtained; although, it was very tight due to the chronic nature of the rupture. Next, the wound was thoroughly irrigated with normal saline. The retinaculum on either side was closed with #1 Ethibond suture in a figure-of-eight fashion. The 0-Vicryls were used to sew over the superficial layer of the tendons to retinaculum of the patella. Next, the subcutaneous layer was closed with 2-0 Vicryl suture in an inverted fashion followed by staples for the skin. Prior to closure, the tourniquet was deflated and hemostasis was obtained. Next, sterile dressings were applied after staples were placed on the skin and the patient was placed into the knee immobilizer. He was then awakened from anesthesia and transferred back on to the stretcher and taken to the PACU for recovery.
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