Rupture of the quadriceps tendon is a relatively uncommon injury that requires prompt surgical intervention to restore the function of the extension apparatus of the knee. Early, definitive surgical intervention generally produces excellent results. In the case of delayed surgery or re-rupture, the tendon is often retracted and scarred, thus complicating subsequent repairs and resulting in poor outcomes. We describe a middle-aged man who presented 4 years after his initial quadriceps rupture, following two repair attempts that failed. Upon presentation, he was unable to perform any active extension at the knee, and he ambulated with the use of a hinged brace locked in extension. Owing to central tendon deficiency, previously described V-Y advancement was contraindicated, so we developed a novel surgical technique. His quadriceps tendon was successfully reconstructed using a combination of soft-tissue releases, tendon transposition, and allograft reinforcement. His postoperative course was uneventful, and at 5 months, he was ambulating comfortably without a brace, showing full active motion and good quadriceps strength.

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