Chronic quadriceps rupture repair: Chambat technique or sardine tin technique

Background: Quadriceps tendon ruptures account for less than 2% of knee extensor injuries. While acute repairs typically yield favorable outcomes, chronic ruptures—defined by a delay exceeding three weeks—present significant surgical challenges. Tendon retraction and fibrous adhesions often necessitate complex reconstruction methods, such as V-Y lengthening plasties, autografts, or allografts, which may be associated with donor site morbidity or patellar weakening.

Objective: This article describes a direct tendon reinsertion technique reinforced with a temporary metal frame to address tendon retraction in chronic injuries without the requirement for supplemental grafting.

Key Points: The procedure involves an anterior longitudinal incision and excision of fibrous tissue to expose the tendon stump. Three 2 mm transosseous tunnels are created in the patella. A 2 mm transverse pin is placed through the patella and another through the proximal tendon stump. Metal wires are looped between these pins, allowing for the gradual distal mobilization of the retracted quadriceps tendon toward the proximal patellar pole. Once positioned, reinsertion is performed using high-strength sutures through the transosseous tunnels. Postoperative management includes 45 days of immobilization in extension with progressive weight-bearing and restricted range of motion. This method utilizes standard equipment and minimizes the risk of patellar fracture by avoiding large-diameter tunnels required for graft passage.

Conclusion: This technique provides a reliable, cost-effective solution for chronic quadriceps tendon ruptures. Utilizing a metal frame for mechanical traction facilitates stable reinsertion of retracted tendons while avoiding the morbidity associated with autologous or allogeneic grafts.