Muscle injuries are challenging problems for surgeons. Most of muscle trauma are treated conservatively with excellent results but severe muscle injury may indicate the need for surgical repair. Repair of belly muscle laceration is technically demanding because of the sutures pull out and the likelihood of clinical failure is high. Different suture techniques have been described in literature even if the best suturing technique is debated. Moreover many biological approaches to improve muscle healing have been proposed. We present a case of complete quadriceps muscle tear treated with surgical repair at 5 years follow-up and a review of literature.