Damage to the quadriceps and patellar tendons of the extensor mechanism can be devastating and often life-changing injuries that require prompt diagnosis and treatment. A sound understanding of anatomy, biomechanics, and degenerative changes of both tendons and the extensor mechanism of the knee can help guide surgical repair and postoperative rehabilitation of patients. Immediate primary repair has often resulted in improved postoperative results compared with delayed reconstruction, and the avoidance of gap formation by use of careful techniques and augmentation has been critical for successful treatment. Additionally, patients with extensor mechanism injuries frequently have medical comorbidities or notable tendon degeneration; subsequently, careful consideration of systemic diseases and appropriate medical treatment has been vital to success of operative treatment. I reviewed the anatomy of quadriceps and patellar tendons; biomechanics of the extensor mechanism and tendons; mechanisms of injury; clinical and biomechanical studies on use of surgical techniques for treatment; and postoperative rehabilitation protocols and possible complications. Early diagnosis, awareness of comorbidities, prompt surgical treatment using a careful approach, and a thorough postoperative rehabilitation program may allow patients to return to previous levels of activity, with promising longterm results.

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