Autograft Augmentation of Patellar Tendon Rupture Allows Better Functional Outcomes and Less Reoperation Than Steel Wire Cerclage

Background: Patellar tendon rupture is uncommon but can severely impair knee extension and functional recovery. Most injuries occur during sports involving eccentric quadriceps loading, often with valgus stress. Traditional repair using transosseous sutures reinforced with steel wire cerclage provides initial stability but carries drawbacks, including hardware irritation, stiffness related to immobilization, and the frequent need for secondary removal. Biological augmentation with hamstring tendon autograft has emerged as an alternative that avoids hardware-related morbidity while potentially improving tendon healing. Hypothesis: Hamstring tendon autograft augmentation would yield superior functional outcomes and knee motion without increasing complications or rerupture, and it would reduce reoperations by avoiding routine hardware removal compared with steel wire cerclage reinforcement for acute patellar tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective multicenter analysis across 5 sports medicine centers identified patients treated between February 2011 and May 2023 for isolated patellar tendon rupture or inferior pole patellar avulsion. A total of 81 patients met inclusion criteria. Patients underwent either hamstring tendon autograft augmentation (autograft augmentation group [AAG]; n = 43; semitendinosus ± gracilis through transosseous tunnels) or steel wire cerclage (synthetic augmentation group [SAG]; n = 38). The primary outcome was the Lysholm Knee Score. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, the University of California Los Angeles Activity Scale, the Forgotten Joint Score-12, knee range of motion, return to preinjury sport and work, complications, reoperations, and patellar height (Caton-Deschamps). Minimum follow-up was 24 months. Results: = .50). Patellar height was preserved after AAG but decreased after SAG. Conclusion: In this multicenter cohort with ≥2-year follow-up, hamstring tendon autograft augmentation produced superior functional outcomes, greater flexion, higher return to sport, and fewer complications and reoperations compared with steel wire cerclage, without increasing rerupture risk. These findings support autograft augmentation as a preferable reinforcement strategy for active patients with acute patellar tendon rupture.