Extensor Mechanism Reconstruction for Chronic Patellar Fracture

Patients with displaced patellar fractures typically present with disruption to the extensor mechanism requiring acute surgical intervention. Chronic patellar fractures with disruption of the extensor mechanism are uncommon, and few surgical options are available. The authors present a patient who sustained a fracture to the inferior pole of the patella in Africa 5 years prior that was managed conservatively with bands and a brace. He decided to pursue surgical intervention because of difficulties with leg extension, weakness, and ambulation. The patient underwent a novel reconstruction of his chronic extensor mechanism loss with a combination of inferior pole patellar fracture excision, z-plasty and lengthening of the quadriceps tendon, and Achilles tendon reconstruction of the patellar tendon with both hamstring autograft and acellular human dermal matrix allograft augmentation of the entire reconstruction construct. At the final 2-year follow-up, the patient had restored active extension with no extensor lag and had returned to his preinjury activities, including running and playing soccer.