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Shah MM, Raibagkar S, Bansal S, Jain M, Ponugoti G. Patellar Tendon Rupture During Postoperative Physiotherapy for Crouch Gait: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00047. [PMID: 38096336 DOI: 10.2106/jbjs.cc.23.00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
INTRODUCTION A 14-year-old adolescent girl with spastic diplegic cerebral palsy underwent bilateral distal femur extension osteotomy and patellar tendon plication. Two and a half months after surgery, during physiotherapy, she sustained mid-substance tear of the left patellar tendon. The girl was successfully managed with patellar tendon repair and augmentation with tensor fascia lata autograft. CONCLUSION Patellar tendon rupture during rehabilitative physiotherapy after patellar tendon plication surgery is rare. Postoperative protocols in patients with cerebral palsy are crucial and should progress gradually to improve knee range of motion. This report highlights that patellar tendon repair with fascia lata augmentation yields good outcome.
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Fernandes A, Rufino M, Hamal D, Mousa A, Fossett E, Cheema KS. Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review. Cureus 2023; 15:e41512. [PMID: 37426403 PMCID: PMC10327612 DOI: 10.7759/cureus.41512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/11/2023] Open
Abstract
The extensor mechanism of the knee can be damaged due to various modes of injury, which, in most cases, will require urgent surgical intervention for repair. Single patellar tendon ruptures are uncommon, but simultaneous bilateral events are even rarer and have been scarcely reviewed in English literature. Research in this area is mainly confined to case series, with some literature reviews but no evidence of more substantial analysis. Therefore, this systematic review was done to analyse the existing literature on bilateral simultaneous patellar tendon ruptures and propose a systematic and standardised approach to diagnosing and managing these injuries. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search terms included 'bilateral patellar tendon rupture', 'bilateral', 'patellar', 'tendon' and 'rupture'. Three independent reviewers conducted searches in PubMed, OvidSP for Medline, Embase and the Cochrane Library using the same search strategy. The eligibility criteria included studies on bilateral concomitant patellar tendon rupture published in English. Bilateral simultaneous patellar tendon ruptures of traumatic and atraumatic origin in human patients were included. The study types comprised case reports and literature reviews. The key limitation of this study was the low number of patients covered by the eligible literature. Patellar tendon ruptures are a rare and scarcely documented injury, and there is a need for studies with a high level of evidence, especially regarding surgical treatment choice and methods, as well as post-operative management, which could potentially lead to improved outcomes in the management of this injury.
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Affiliation(s)
- André Fernandes
- Trauma and Orthopaedics, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, GBR
| | - Mariana Rufino
- Respiratory Medicine, Wirral University Teaching Hospital NHS Foundation Trust (WUTH), Wirral, GBR
| | - Divakar Hamal
- Anesthesiology, Hull University Teaching Hospital, Hull, GBR
| | - Amr Mousa
- Surgery, The Hillingdon Hospital NHS Foundation Trust, London, GBR
| | - Emma Fossett
- Trauma and Orthopaedics Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - Kamalpreet S Cheema
- Trauma and Orthopaedics Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
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Rose MT, Caldwell PE, Vizzi S, Pearson SE. Distal Patellar Tendon SpeedBridge Repair. Arthrosc Tech 2020; 10:e9-e13. [PMID: 33532201 PMCID: PMC7823059 DOI: 10.1016/j.eats.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/10/2020] [Indexed: 02/03/2023] Open
Abstract
Patellar tendon ruptures are rare injuries in young athletes, resulting in disruption of the extensor mechanism, and require surgery for functional recovery. Several techniques have been reported, including end-to-end repair and single-row suture anchor constructs. The strength of these repairs has been questioned, and they are commonly augmented. We endorse a double-row repair technique that provides an anatomic restoration of the footprint, has high fixation strength, eliminates the need for graft augmentation, and allows early motion.
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Affiliation(s)
- Mark T. Rose
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell III, M.D., Tuckahoe Orthopaedic Associates, 1501 Maple Ave, Ste 200, Richmond, VA 23226, U.S.A.
| | - Scott Vizzi
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A
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Patellar Tendon Avulsion with Tibial Tuberosity Sleeve Fragment. Case Rep Orthop 2019; 2019:6193498. [PMID: 30993025 PMCID: PMC6434298 DOI: 10.1155/2019/6193498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 11/17/2022] Open
Abstract
Rupture of the patellar tendon is relatively rare. We report a case of patellar tendon avulsion with a tibial tuberosity sleeve fragment in pediatric patient. In pediatric patient, diagnosis is sometimes difficult due to uncompleted ossification. In the present case, which involved the presence of a small fleck of bone from tibia, we were able to attain a diagnosis using the Koshino-Sugimoto index and MRI and easily determine the optimal treatment with the use of the suture anchor and tension band wiring method.
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Holbeck-Brendel J, Rahbek O. 5-year-old child with late discovered traumatic patellar tendon rupture-a case report. Acta Orthop 2018; 89:454-456. [PMID: 29723072 PMCID: PMC6066764 DOI: 10.1080/17453674.2018.1467846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jesper Holbeck-Brendel
- Department of Orthopaedic Surgery, Aarhus University Hospital; ,Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark,Correspondence:
| | - Ole Rahbek
- Department of Orthopaedic Surgery, Aarhus University Hospital; ,Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Ali Yousef MA, Rosenfeld S. Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature. Injury 2017; 48:2515-2521. [PMID: 28888715 DOI: 10.1016/j.injury.2017.08.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased. OBJECTIVE To evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries. METHODS Demographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score. RESULTS Five male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12-15 years). The injury occurred in relation to sports activities in 4 patients. Osteogenesis imperfecta and Osgood-Schlatter disease were identified in 2 patients. High riding patella is the hallmark diagnostic sign detected in plain x-ray with preoperative Insall-Salvati ratio ranged from 1.7 to 2.5. Three patients had pure soft tissue avulsion distally from the proximal tibia, 1 patient had pure soft tissue avulsion proximally from the inferior patellar pole, and 1 patient with midsubstance tendinous disruption. No associated intra-articular lesions were identified. Suture bridge double row technique, transpatellar suturing, and transosseous suturing through the proximal tibia were used for patellar tendon reinsertion. After a mean follow-up period of 18. 4 weeks (range: 10-30 weeks), patients achieved AROM ranging from 0 to 120° to 0-137° without terminal extension lag. The mean time to return to sports activity was 22 weeks (range: 13-30 weeks). Quadriceps muscle strength was 5/5 at the final follow-up visit in all patients; however, relative muscle atrophy was noted in comparison to the other side in one patient. The mean KSS was 91.8 points (range: 79-100 points) with excellent outcome in 4 patients and good outcome in 1 patient. CONCLUSION Patellar tendon rupture is rare in the pediatric population and represents 7% of pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. Ruptures may occur midsubstance, or from proximal or distal insertions. High riding patella is the hallmark diagnostic sign for such injury. Although rare, it is considered a serious injury that necessitates early diagnosis and surgical intervention. Functional range of motion was obtained in all patients with different modalities of treatment.
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Affiliation(s)
| | - Scott Rosenfeld
- Department of Orthopaedic Surgery, Texas Children's Hospital, Houston, TX, USA
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Acute Traumatic Patellar Tendon Rupture at the Tibial Tuberosity Attachment without Avulsion Fracture. Case Rep Orthop 2017; 2017:2537028. [PMID: 28856026 PMCID: PMC5569638 DOI: 10.1155/2017/2537028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/17/2017] [Indexed: 11/24/2022] Open
Abstract
Patellar tendon rupture in children is especially rare. The fact that the area of traumatic rupture has wide variations makes surgical treatment difficult. We present an 11-year-old boy with acute traumatic patellar tendon rupture at the tibial tuberosity attachment without avulsion fracture. Primary end-to-end repair and reinforcement using 1.5 mm stainless steel wires as a surgical strategy were undertaken. Early range of motion began with a functional knee brace and the reinforced stainless wire was removed 3 months after surgery. Knee function at the final follow-up was satisfactory. We suggest that this strategy may provide a useful option for surgical treatment.
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Felt J, Arora R. Patellar Tendon Rupture in a Pre-Adolescent Male. J Pediatr 2017; 180:283-283.e1. [PMID: 27742122 DOI: 10.1016/j.jpeds.2016.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Rajan Arora
- Pediatric Emergency Medicine Children's Hospital of Michigan Carmen and Ann Adams Department of Pediatrics Wayne State University Detroit, Michigan
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Williams D, Kahane S, Chou D, Vemulapalli K. Bilateral Proximal Tibial Sleeve Fractures in a Child: A Case Report. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e27898. [PMID: 26566509 PMCID: PMC4636667 DOI: 10.5812/atr.27898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 03/15/2015] [Indexed: 12/04/2022]
Abstract
Introduction: A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare. Case Presentation: In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome. Conclusions: We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems.
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Affiliation(s)
- Daniel Williams
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
- Corresponding author: Daniel Williams, Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK. Fax: +44-1689850915, E-mail:
| | - Steven Kahane
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
| | - Daud Chou
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
| | - Krishna Vemulapalli
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
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Pires e Albuquerque RS, de Araújo GCS, Labronici PJ, Gameiro VS. Patellar ligament rupture in an adolescent. BMJ Case Rep 2015; 2015:bcr-2014-208070. [PMID: 25743861 DOI: 10.1136/bcr-2014-208070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rupture of the patellar tendon is a well-known injury in the orthopaedic literature. However, it is unusual and rarely reported in adolescent children. On the one hand, in the immature skeleton, the most frequent lesion above the kneecap is the sleeve fracture. On the other hand, in the distal region, avulsion of the tibial tuberosity is more common. Patellar tendon rupture in an adolescent is a rare lesion. We report a case in which an adolescent sustained a fall when jumping. No predisposing factors have been found. The injury was treated with surgical repair with transosseous suturing and reinforcement with semitendinosus tendon. The aim of this study is to present a case of traumatic rupture of the extensor mechanism of the knee in an adolescent and the therapy used.
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11
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Bilateral tibial tubercle sleeve fractures in a skeletally immature patient. Case Rep Orthop 2013; 2013:969405. [PMID: 23691395 PMCID: PMC3638528 DOI: 10.1155/2013/969405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sleeve fractures with suture anchor fixation. At the final followup, 3 years after his initial injury, the patient demonstrated full knee function bilaterally without radiographic evidence of growth disturbances.
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12
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Albuquerque RP, Giordano V, Albuquerque MIP, Carvalho ACP, do Amaral NP, Barretto JM. SIMULTANEOUS BILATERAL TEAR OF THE KNEE EXTENSOR MECHANISM IN A PRE-ADOLESCENT: CASE REPORT. Rev Bras Ortop 2012; 47:659-61. [PMID: 27047882 PMCID: PMC4799452 DOI: 10.1016/s2255-4971(15)30020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/04/2011] [Indexed: 11/05/2022] Open
Abstract
Unilateral tearing of a patellar tendon and a contralateral sleeve fracture in a pre-adolescent are rare lesions. We report a case in which a pre-adolescent sustained a fall while jumping during a soccer match. No predisposing risk factors were identified. The injuries were treated with surgical repairs and transosseous suturing. The aim of this study was to present a case of spontaneous concurrent tearing of the extensor mechanism of the knee in a pre-adolescent.
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Affiliation(s)
- Rodrigo Pires Albuquerque
- MSc and PhD in Medicine; Orthopedist and Coordinator of the Knee Surgery Sector, SOT-HMMC, Rio de Janeiro, RJ, Brazil
| | - Vincenzo Giordano
- MSc in Medicine; Orthopedist and Coordinator of the Medical Residence Program, SOT-HMMC, Rio de Janeiro, RJ, Brazil
| | | | - Antonio Carlos Pires Carvalho
- Associate Professor in the Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - João Maurício Barretto
- MSc and PhD in Medicine; Head of the Orthopedics Service, Santa Casa do RJ, Rio de Janeiro, RJ, Brazil
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Kolovich GP, Griesser MJ, Davis C, Granger JF. Asymptomatic Bilateral Patella Alta After Surgical Repair of Traumatic, Sequential Bilateral Patellar Tendon Rupture: A Case Report. JBJS Case Connect 2011; 1:e8. [PMID: 29252224 DOI: 10.2106/jbjs.cc.k.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Gregory P Kolovich
- Department of Orthopaedics, The Ohio State University, 4110 Cramblett Hall, 456 West 10th Avenue, Columbus, Ohio 43210.
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Concurrent bilateral patellar tendon rupture in a preadolescent athlete: a case report and review of the literature. J Pediatr Orthop B 2010; 19:511-4. [PMID: 20595921 DOI: 10.1097/bpb.0b013e32833cb7a0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Concurrent bilateral patellar tendon rupture in preadolescence is a very rare condition. It is mostly associated with systemic disease or steroid use in adults. We report a case of 12-year-old boy, who had bilateral patellar tendon rupture, treated with nonabsorbable synthetic suturing with titanium osseous anchors. Moreover, we discuss the causes of patellar tendon rupture, diagnostic clues and surgical options.
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Wang Z, Wang Q, Tang H, Kang Y. Extensor mechanism repair and reconstruction using Achilles tendon allograft after bilateral patellar tendon rupture in a patient with rheumatoid arthritis. Knee Surg Sports Traumatol Arthrosc 2010; 18:1113-5. [PMID: 20033671 DOI: 10.1007/s00167-009-1021-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 12/04/2009] [Indexed: 11/29/2022]
Abstract
Here we report spontaneous rupture of the bilateral patellar tendons in a 49-year-old man with rheumatoid arthritis. The ruptured tendons were sutured via bone tunnels using Krackow stitch, and the extensor mechanism of the knee was reinforced with three bundles of allograft Achilles tendons. The patient recovered well after operation. He could actively flex, extend the knees and carry out full-weight-bearing activities, and he resumed the former employment 6 months after the operation. Follow-up showed that the patient had satisfactory range of motion of the knees 1 year later.
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Affiliation(s)
- Zimin Wang
- Department of Orthopaedic Surgery, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
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Moretti B, Notarnicola A, Moretti L, Garofalo R, Patella V. Spontaneous bilateral patellar tendon rupture: a case report and review of the literature. ACTA ACUST UNITED AC 2008; 91:51-5. [DOI: 10.1007/s12306-007-0009-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 11/02/2007] [Indexed: 11/28/2022]
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