Distal Femoral Replacement and Extensor Mechanism Repair Reinforced With Synthetic Mesh for Distal Femur Fracture With Patellar Ligament Avulsion

Acute patellar ligament disruption in the setting of a distal femur fracture is an uncommon presentation with a variety of treatment options available to the practitioner. The following case report presents an 85-year-old female with a highly comminuted supracondylar distal femur fracture with intercondylar extension and a soft-tissue avulsion of the patellar ligament insertion discovered intraoperatively. A detailed technique review for acute patellar ligament repair with suture anchors and synthetic mesh reinforcement in the setting of distal femoral replacement is then provided. One-year follow-up revealed an intact extensor mechanism with minimal extensor lag and a painless gait. Surgeons faced with such a unique, complex problem may consider mesh augmentation of an acute patellar ligament repair while performing distal femoral replacement.