# The Lister Reconstruction: A Novel Technique to Reconstruct the Patellar Tendon

## TL;DR

A new surgical technique is introduced for reconstructing chronic patellar tendon ruptures using hamstring grafts and adjustable fixation.

## Contribution

The Lister Reconstruction combines direct repair with hamstring autograft augmentation and adjustable fixation for patellar tendon reconstruction.

## Key findings

- The technique restored patellar height and alignment confirmed by intraoperative imaging.
- The patient showed satisfactory functional recovery with no graft failure.
- This is the first reported case using this specific combination of surgical methods.

## Abstract

Chronic patellar tendon ruptures are uncommon but debilitating injuries that present a significant reconstructive challenge, particularly in the context of pre-existing tendinopathy. Direct repair is frequently not feasible due to tendon retraction, poor tissue quality, and proximal patellar migration, necessitating augmentation or reconstruction techniques.

We report a novel method of patellar tendon reconstruction in a 27-year-old male with a chronic rupture and underlying tendinopathy. The technique combines direct repair with hamstring autograft augmentation, utilizing an adjustable suspensory loop device for proximal fixation at the inferior pole of the patella and a transosseous tibial tunnel with interference screw fixation distally. This approach restores the native vector of the patellar tendon while permitting intraoperative adjustment of patellar height. After harvest of the gracilis and semitendinosus autografts, tunnels were prepared in the patella under fluoroscopic guidance. Adjustable cortical fixation was employed proximally with docking of the graft at the inferior pole, while distal fixation was achieved through a tibial tunnel. The residual native tendon was repaired with Krakow sutures, supplemented by autograft augmentation, and reinforced with retinacular closure. Intraoperative imaging confirmed restoration of patellar height and alignment.

The patient was mobilized with a range-of-motion brace and partial restrictions. Intra-operative radiographs confirmed maintenance of patellar height, with satisfactory functional recovery and no evidence of graft failure.

To our knowledge, this is the first reported case of patellar tendon reconstruction combining direct tendon repair with hamstring autograft augmentation using adjustable suspensory loop fixation proximally and transosseous tibial tunnel fixation distally. This construct provides both biological reinforcement and biomechanical stability, while restoring the native pull vector of the extensor mechanism. Further evaluation in larger series is warranted to determine long-term functional outcomes and graft incorporation.