# Pedicled Rectus Femoris Flap for Restoration of Suprapatellar Quadriceps Tendon and Defect Coverage after Multiple Reconstruction Attempts—A Case Report and Literature Review

## TL;DR

This paper presents a successful surgical technique using a pedicled rectus femoris flap to restore knee function and cover tissue defects in patients with complex suprapatellar injuries.

## Contribution

The paper introduces the pedicled rectus femoris flap as a novel and effective solution for simultaneous tendon restoration and tissue coverage in challenging cases.

## Key findings

- Both patients regained unaided walking ability three months post-surgery.
- Knee joint mobility and active extension were restored in both patients after six months.
- The flap provided reliable functional outcomes and soft-tissue coverage with minimal donor site complications.

## Abstract

There is no unified approach for restoring the suprapatellar quadriceps tendon and covering tissue defects simultaneously. In this case report, we present the pedicled myocutaneous rectus femoris flap as one effective approach in two cases with extensive loss or impairment of the suprapatellar muscle–tendon structures after trauma-related suprapatellar quadriceps tendon rupture and multiple reconstruction attempts. Additionally, we provide a literature review of the reconstructive use of the functional pedicled myocutaneous rectus femoris flap. Methods: Two male patients, 48 and 74 years old, with extensive loss or impairment of the suprapatellar muscle–tendon structures due to multiple reconstruction attempts, underwent restoration of the knee extension with a pedicled myocutaneous rectus femoris flap. Results: Three months after reconstruction, both patients were able to walk freely, unaided. After a six-month follow-up, the free passive mobility of the knee joint was restored, and the active extension of the knee joint was possible in both patients. Conclusion: The authors conclude that the pedicled rectus femoris flap is a reliable method for the restoration of knee extension, with excellent functional results in cases of suprapatellar tendon lesions. Further to the functional restoration, this technique has the additional advantage of simultaneously achieving coverage of soft-tissue defects, while a direct closure of the donor site is possible. Elderly patients and patients with relevant comorbidities or multiple revisions may especially benefit from this technique.