Complex patellar tendon reconstruction using a peroneus longus autograft and structural cortical bone graft after multiple failures: a case report

Patellar tendon rupture is an uncommon but disabling injury of the knee extensor mechanism. Chronic rupture and repeated repair failure are associated with tendon degeneration, patella alta, and compromised bone stock, making reconstruction challenging and without a standardized approach. We report a 41-year-old male with spontaneous patellar tendon rupture following tendinopathy, with two failed repairs evolving to re-rupture, patella alta, and severe bone loss of the inferior patellar pole. Reconstruction was performed using suture anchors, structural autologous cortical bone graft from the distal tibia, and augmentation with a peroneus longus tendon autograft. At 26 weeks, the patient achieved full active extension, range of motion from 0° to 120°, improved patellar height, and significant functional recovery. This combined biological and structural approach may represent a viable option in complex revision cases with tendon and bone deficiency.