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Fortier LM, Adelstein JM, Sinkler MA, Moyal AJ, Burkhart RJ, Vakharia AM, Dasari SP, Chahla J. Patellar tendon restoration techniques: a systematic review of outcomes for repair and reconstruction methods. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04078-3. [PMID: 39212690 DOI: 10.1007/s00590-024-04078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This systematic review aims to delineate the various methods to repair or reconstruct the patellar tendon using the available literature. METHODS MEDLINE and PubMed electronic databases were searched for English language clinical studies involving patellar tendon rupture repair or reconstruction that reported patient-reported outcome scores (PROS) between January 1st, 1953 and June 17th, 2021. Data was extracted on full text articles to collect functional outcome scores and rupture category, including acute, chronic, post-total knee arthroplasty (TKA) and post-anterior cruciate ligament reconstruction (ACLR). RESULTS Twenty-three studies with a total of 738 patients were included. Of the 14 studies including acute repairs, mean postoperative Lvsholm scores ranged from 84 to 99.5. Knee Society Score (KSS) and knee range of motion (ROM) measurement were the most widely reported outcomes in the chronic setting. The average postoperative KSS scores ranged from 70 to 87.7. Of the six studies that included patellar tendon repairs/reconstructions in the setting of prior TKA, the most frequently reported outcomes were KSS scores and knee ROM measurements. The average postoperative KSS scores for the three cohorts reporting reconstruction with allograft ranged from 79 to 88 as compared to the average postoperative KSS score for reconstruction with autograft of 70. CONCLUSION Despite this heterogeneity, we concluded: (1) in the primary setting, cerclage augmentation yields the lowest lysholm scores and should not be considered, although primary repairs with and without augmentation yield comparable postoperative lysholm scores, (2) in the chronic setting, repair with augmentation and reconstruction yielded similar results aside from in post-TKA patients where allograft reconstruction yielded superior KSS scores.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jeremy M Adelstein
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Andrew J Moyal
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Robert J Burkhart
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ajit M Vakharia
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Suhas P Dasari
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
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Li X, Cao W, Zhou H, Ji R, Xiao J, Zhao C. The healing effect of the all inside technique is superior to the traditional technique in the reconstruction of the anterior cruciate ligament. Eur J Transl Myol 2024; 34:11970. [PMID: 38351844 PMCID: PMC11017173 DOI: 10.4081/ejtm.2024.11970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 03/28/2024] Open
Abstract
Our main objective was to examine the curative effect of all inside technique and traditional technique in anterior cruciate ligament (ACL) reconstruction. In our retrospective study at the First People's Hospital of Jiashan County, we analyzed 88 participants with ACL injuries (50 males, 38 females, average age 27 years). They were randomly divided into two groups: traditional ACL reconstruction (42 participants) and all inside ACL reconstruction (46 participants). We measured and recorded the Visual Analog Scores (VAS), International Knee Documentation Committee (IKDC), Lysholm scores, operation time, graft diameter and length between the traditional technique group and all inside technique group. There were statistically significant differences in the Lysholm scores and IKDC scores between traditional and all inside technique groups. The all inside technique showed a higher efficacy and effective post-operative recovery with minimal pain and recurrent injuries. Our findings showed that the differences in gender, age, side of injury and operation time were not significant (p> 0.05). Follow-up was conducted at 6 months and 12 months post operations (mean, 7.5 ± 1.1 months). All inside technique minimizing tissue disruption, optimizing graft placement and facilitating early recovery have a significant impact on patient outcomes.
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Affiliation(s)
- Xiong Li
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Wu Cao
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Hongyu Zhou
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Ruida Ji
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Jian Xiao
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Chen Zhao
- Department of Orthopedics, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang.
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Jurgensmeier K, Kweon CY. Reconstructing a Patellar Tendon Rupture Neglected for 14 Years When Anatomic Restoration Is Not Possible: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00014. [PMID: 37478318 DOI: 10.2106/jbjs.cc.23.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
CASE This case highlights the utility and outcomes of an Achilles tendon bone-block allograft in reconstructing the patellar tendon of a 44-year-old man in the setting of a high-riding, irreducible patella after a chronic patellar tendon rupture of 14 years. CONCLUSION In cases of a neglected patellar tendon rupture with an irreducible high-riding patella, an Achilles tendon bone-block allograft can provide the length and tissue necessary to reconstruct the extensor mechanism. Although reconstruction may not be anatomic, patients can still experience great subjective and objective functional improvement with restoration of the extensor mechanism even after delayed reconstruction.
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Affiliation(s)
| | - Christopher Y Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Zhou M, Long Y, Yu M, Guo J, Tang Y, Li F, Li Q, Zhang Y, Zheng Z, Hou J, Yang R. Allogeneic Tendon Transplantation for the Treatment of Pathological Patellar Ligament Defect in Children: Technical Note and 4-Year Follow-Up. Orthop Surg 2022; 14:3431-3440. [PMID: 36321600 PMCID: PMC9732635 DOI: 10.1111/os.13475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The absence of patellar ligament will bring about a severe negative impact on daily life. Many reconstruction techniques have been described in adults. However, there is a lack of technical introduction regarding the reconstruction of the patellar ligament in children. The purpose of this study was to report a surgical technique for reconstructing the patellar ligament in children. METHOD A retrospective analysis of the clinical data on a patellar ligament (tendon sheath fibroma) patient with allogeneic tendon reconstruction. An 8-year-old child with postoperative recurrence of left patellar ligament tumor was enrolled in our study. Anterior tibialis tendon allograft was used to reconstruct the patellar ligament after complete resection of the patellar ligament for the tumor. The tunnels were constructed on the deep surface of the tibial tubercle and the root of the quadriceps tendon (to decrease the harmful impact on patella development), respectively. The allogeneic tendon was passed through the tunnels above in the shape of "8," and the two ends of the tendon were attached to the bleeding bone bed at the inferior edge of the patella with suture anchors to achieve better bone-tendon healing. During the follow-up, the knee's range of motion and imaging manifestations were recorded. RESULT Postoperative pathology suggests chondromesenchymal hamartoma, a rare benign soft tissue tumor different from the previous operation (tendon sheath fibroma). During the 4-year follow-up, the patient's active range of motion of the knee achieved 0° to 120°; and the patient could walk normally without any external help. Physical examinations (the apprehension sign and J sign) showed no ligamentous instability or patellar ligament tenderness. Imaging analysis showed that the ratio length of the patellar ligament to the patella was almost normal. The integrity, continuity, and shape of the allogeneic ligament showed excellent results in MRI. Combined with clinical and imaging findings, allogeneic tendon patellar ligament reconstruction was deemed successful. CONCLUSION Allogeneic ligament reconstruction technique can provide a treatment option by reconstructing the extensor mechanism, minimizing the impact on patellar development, and augmenting biological healing for children with the absence of the patellar ligament.
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Affiliation(s)
- Min Zhou
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yi Long
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Menglei Yu
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Jiang Guo
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yiyong Tang
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Fangqi Li
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Qingyue Li
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yuanhao Zhang
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Zhenze Zheng
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Jingyi Hou
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Rui Yang
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
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Silva R, Pereira EC, Distefano M, Toon R, Verhaegen J, Lagae K, Verdonk P. A novel technique with Dacron vascular graft augmentation for knee extensor mechanism repairs: Technical note. SICOT J 2022; 8:31. [PMID: 35969122 PMCID: PMC9377215 DOI: 10.1051/sicotj/2022034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Ruptures of the extensor apparatus can have different etiologies and be complicated by underlying situations. Direct repair is not always possible, and reconstruction procedures can be insufficient, which leads to the appearance of multiple augmentation techniques to improve the strength of these constructs. Despite the proven results of these techniques, numerous procedures are described without any gold standard. We present our augmentation method for repairing the knee extensor apparatus with a vascular prosthesis that facilitates healing, does not interfere with the primary procedure, has no donor morbidity or rejection risk, and allows earlier mobilization and rehabilitation. The technique was used in different cases with multiple etiologies that needed reinforcement, with promising results.
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Affiliation(s)
- Rómulo Silva
- Unidade Local de Saúde do Alto Minho, 4904-858 Viana do Castelo, Portugal
| | | | - Marco Distefano
- Università degli Studi di Firenze, AOU Careggi, 50121 Firenze, Italy
| | - Roskams Toon
- Faculty of Medicine and Life Sciences, University of Antwerp, 2610 WILRIJK Antwerp, Belgium
| | | | - Koen Lagae
- Orthoca, AZ Monica, 2100 Antwerp, Belgium
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Double-Row Suture Anchor Fixation and Achilles Allograft Augmentation for Chronic Patellar Tendon Rupture Repair. Arthrosc Tech 2022; 11:e631-e638. [PMID: 35493057 PMCID: PMC9051965 DOI: 10.1016/j.eats.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023] Open
Abstract
Patellar tendon ruptures are functionally devastating injuries that result in failure of the knee extensor mechanism and can lead to a loss of ambulation. Chronic patellar tendon injuries are defined as tears greater than 2 weeks old and are typically more complex to manage than acute tears. Recently, the use of double-row suture anchor configurations has been explored as a technique to provide improved strength in addition to tendon-to-bone compression at the anatomic footprint. The purpose of this article is to describe a surgical technique involving chronic patellar tendon rupture repair using a double-row suture construct augmented with Achilles allograft. Our technique offers a variety of benefits and permits early postoperative mobilization.
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Achilles Tendon Allograft with Semitendinosus Autograft Reinforcement Is a Successful Treatment for Chronic Patellar Tendon Rupture: Report of Two Cases. Case Rep Orthop 2021; 2021:9951754. [PMID: 34422423 PMCID: PMC8371642 DOI: 10.1155/2021/9951754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/18/2021] [Indexed: 11/23/2022] Open
Abstract
Rupture of the patellar tendon must be diagnosed urgently because reconstruction of the extensor mechanism produces better results when it is performed in acute conditions. Reconstruction of chronic extensor mechanism rupture on the contrary is very challenging. Several surgical techniques have been described using a variety of graft choices and fixation methods, but the optimal approach is still under debate. We report our experience of two cases of chronic patellar tendon rupture reconstruction using an Achilles tendon allograft reinforced by a vascularized ipsilateral semitendinosus tendon frame. The rapid functional recovery of the range of motion, only three months postoperatively, showed us that this reconstruction technique was effective.
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