Management of Acute Midsubstance Patella Tendon Rupture: Current Concepts and Clinical Narrative Review.

» Midsubstance patellar tendon repairs are rare, technically demanding surgeries that are distinct from proximal and distal avulsions due to the challenges of tendon-to-tendon healing and zone of injury tissue quality.» Primary repair using the Krackow suturing technique remains the most widely used method, often combined with patellar and tibial-based fixation.» Protective constructs such as high-strength suture configurations or cerclage wire are employed to share load with the repair site and support healing and function.» Structural and biological augmentations, including autografts, allografts, synthetic ligaments, and collagen scaffolds, are increasingly used to reinforce the injured extensor mechanism, support repair, and enhance healing, particularly in high-risk or complex patients.» Postoperative rehabilitation protocols vary but generally include a period of immobilization in extension followed by progressive flexion, isometric quadriceps activation, and return to normal activity at 9 to 12 months and return to a preinjury level at 12 to 18 months.