Table 1 Six technical tips for the suture tension band fixation technique

1. Meticulously clear all debris and contused tissue to avoid secondary infection.

2. Reconstruct the patella fragment by fragment and use k-wires to hold the reduction. Use only sutures to hold the achieved reduction.

3. The sutures passed through the quadriceps and patella tendon should be as close to bone as possible to avoid that the sutures secondarily cut through the tendon resulting in slack and potentially displacement.

4. The sutures passed through the quadriceps and patella tendon should grasp the tendons as deep as possible to hold the reduction at the articular surface.

5. Using the “modified circular and figure-of-eight” sutures, a minimum of four strings will cross the anterior surface of the patella, providing a “basket” to contain the reduction of the fragments.

6. The knots should be tied on the lateral aspect of the patella and never on the anterior aspect of the patella to avoid irritation from prominent knots.