Postoperative rehabilitation of simultaneous rupture of anterior cruciate ligament and patellar ligament: A case report

Distal Patellar Tendon Avulsion Associated with an ACL Tear in a Teenager: A Case Report and Review of the Literature

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

Clinical and Biomechanical Outcomes of One-Stage Treatment of a Simultaneous Ipsilateral Patellar Tendon and ACL Tear Combined with a Tibial Plateau Fracture: A Case Study

Simultaneous ipsilateral patellar tendon (PT) and anterior cruciate ligament (ACL) tear is a rare injury. Associated meniscal and ligamentous injuries are common but frequently initially missed. In contrast, to date, there is no report of associated fractures. We report on a 40-year-old female Caucasian patient presenting with a ski injury resulting in simultaneous ipsilateral patellar tendon and ACL tear combined with a tibia plateau fracture and a medial and lateral meniscus lesion. ORIF of the tibia as well as one-stage primary reconstruction of the PT and ACL and suturing of the menisci was conducted. The final follow-up was 2 years postoperatively. Lower extremity kinematic, kinetic, and muscle activity measurements were conducted. Although the clinical result was excellent, altered joint kinematics went along with large side-to-side difference in hip and knee joint moments during midstance and terminal stance. During weight acceptance, vastus medialis and hamstring muscles showed greater relative activity in the injured than the uninjured side. This case demonstrates the possibility of excellent early and midterm results with a one-stage approach and suitable rehabilitation scheme. Biomechanical measurements could further help evaluate the outcome of the treatments and implications for the development of potential secondary damage.