This diagnostic image is a sagittal proton-density magnetic resonance imaging (MRI) scan of the human knee joint, illustrating the anatomy and preoperative measurement protocol for ligament reconstruction. Key visible structures include the distal femur, the patella, the proximal tibia, and the extensor mechanism. The image specifically demonstrates a standardized method for assessing potential donor tissue thickness for autografts, such as Bone-Patellar Tendon-Bone (BPTB) or quadriceps tendon grafts. Two specific measurements are highlighted with yellow lines: a 15 mm segment extending proximally from the superior pole of the patella along the quadriceps tendon, and a 15 mm segment extending distally from the inferior pole of the patella along the patellar tendon. These markers indicate the anatomical locations where tendon thickness should be measured to evaluate graft suitability. The clinical focus of the image is orthopedic preoperative planning for Anterior Cruciate Ligament (ACL) reconstruction, providing a quantitative approach to individualizing surgical graft selection based on the patient's native anatomy.

This clinical photograph displays a two-panel intraoperative view (A and B) of a surgical repair for a quadriceps tendon rupture in a left knee. The patient is in a supine position with the surgical site exposed via a midline longitudinal incision. In panel A, the peritendinous quadriceps tendon is being repaired using a figure-of-8 suture technique with No. 1-0 Vicryl sutures, indicated by a white star. The sutures approximate the anterior soft tissue and retinaculum over the superior pole of the patella. Panel B demonstrates the 'suture bridge' technique, where multiple suture limbs originating from the quadriceps tendon are gathered and secured at the inferior pole of the patella, marked by a blue star. This construct ensures the full thickness of the tendon is reattached to the patellar bone, restoring the extensor mechanism. Surgical retractors are visible, providing visualization of the patellar anatomy and the distribution of high-strength suture material across the repair site. The images illustrate key steps in transosseous tendon-to-bone fixation.

This medical illustration depicts a surgical technique for quadriceps tendon reconstruction using a synthetic mesh graft. The drawing shows the knee joint anatomy including the patella, patellar tendon, and the remnant of the quadriceps tendon. A tubularized mesh, such as a polypropylene mesh, is seen being secured to the proximal quadriceps tendon stump. A surgical needle holder or forceps is shown in the superior-right field, applying a running suture—specifically a Krackow suture technique—to achieve intrasubstance fixation. The mesh is integrated into a longitudinal tunnel within the tendon, providing a scaffold for repair in cases of chronic or recurrent rupture. The illustration focuses on the proximal fixation stage, emphasizing the mechanical anchoring of the graft to the native soft tissue to restore the extensor mechanism of the knee. This pedagogical diagram is intended for orthopaedic surgical education, demonstrating salvage procedures for complex tendon repairs.

This clinical photograph set depicts an intraoperative view of an orthopedic surgical procedure, specifically a quadriceps tendon rupture repair. The image shows a large, open surgical site on the anterior aspect of the knee. The exposed anatomy includes the subcutaneous adipose tissue, the patella, and the proximal retracted stump of the quadriceps tendon. Key visual features involve the application of a tendon graft secured with multiple black, non-absorbable sutures. These sutures are visible anchoring the graft material to both the periosteum at the patellar tunnel exit holes and to the proximal tendon stump using a series of interrupted knots. Hemostasis is partially managed, with visible areas of clotted and fresh blood within the wound bed. The procedural focus illustrated is the terminal stage of a figure-of-eight graft augmentation used to bridge and reinforce the primary quadriceps tendon repair, demonstrating the method of attachment and suture patterns required for functional stability of the extensor mechanism.