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Piedade SR, Górios C, Spiezia F, Maffulli N. Surgical approach on combined chronic patellar tendon and bicruciate knee ligament injury. J Orthop Surg Res 2024; 19:319. [PMID: 38807155 PMCID: PMC11134707 DOI: 10.1186/s13018-024-04724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/06/2024] [Indexed: 05/30/2024] Open
Abstract
A combined injury of the patellar tendon and both the anterior and posterior cruciate ligaments is disabling. It directly affects knee kinematics and biomechanics, presenting a considerable surgical challenge. In this complex and uncommon injury, decision-making should take into account the surgeon's experience and consider one- or two-stage surgery, tendon graft, graft fixation, and rehabilitation protocol. This manuscript discusses the surgical approach based on a comprehensive understanding of the patellar tendon and bicruciate biomechanics to guide which structures should be reconstructed first, especially when a two-stage procedure is chosen.
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Affiliation(s)
- Sérgio Rocha Piedade
- Exercise and Sports Medicine, Department of Orthopaedic, Rheumatology, and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil
| | - Carlos Górios
- Centro Universitário São Camilo, Ipiranga, São Paulo, Brazil
| | - Filippo Spiezia
- Department of Science, Basilicata University, UNIBAS, Potenza, Italy.
- Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo, Potenza, Basilicata, Italy.
| | - Nicola Maffulli
- Department of Orthopaedics and Traumatology, Faculty of Medicine and Surgery, Surgery and Dentistry, Sapienza University, Roma, 00100, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke On Trent, England
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Hahn AK, Coladonato C, Corvi JJ, Patel NK, Sonnier JH, Tjoumakaris F, Freedman KB. Outcomes and Complications Following Chronic Patellar Tendon Repair: A Systematic Review. Cureus 2023; 15:e41713. [PMID: 37575790 PMCID: PMC10414687 DOI: 10.7759/cureus.41713] [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: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
The purpose of this systematic review is to report outcomes and complications following the reconstruction of chronic patellar tendon ruptures. Four databases (Cochrane Database of Systematic Reviews, PubMed, Embase, MEDLINE) were searched from inception to July 2021. Inclusion criteria included articles that (1) analyzed outcomes and complications following chronic patellar tendon reconstruction (>4 weeks from injury to repair), (2) were written in English, (3) greater than five patients, and (4) a minimum 2-year follow-up. Exclusion criteria included (1) non-original research and (2) patellar tendon repair/reconstruction with prior total knee arthroplasty. Data on outcome metrics and complications were extracted from the included studies and reported in a qualitative manner. Nine studies (number of patients = 96) were included after screening. Seven studies analyzed autograft reconstruction, and three of those seven studies analyzed reconstructions with additional augmentation. The remaining two studies evaluated reconstruction utilizing a bone-tendon-bone (BTB) allograft. Four of the autograft studies (n=40 patients) showed a range of post-operative mean Lysholm scores of 74-94. Additionally, four studies reported a post-operative extensor lag of 0-3°. Post-operative protocol for autograft studies included delayed motion and was either contained to a bivalved cast or a hinged knee brace for six weeks. The two allograft studies reported a range of mean Lysholm scores from 62 to 67, and each immobilized the leg in full extension until six weeks. While chronic patellar tendon ruptures are a rare injury of the extensor mechanism, there are viable options for reconstruction. Overall, chronic patellar tendon ruptures reconstructed with both autograft and allograft will provide fair to good outcomes with low complication rates. Following surgery, immobilization for at least six weeks should be emphasized to protect the graft and optimize patient outcomes.
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Affiliation(s)
| | - Carlo Coladonato
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - John J Corvi
- Orthopaedic Surgery, Mount Sinai Hospital, New York, USA
| | - Neel K Patel
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | | | | | - Kevin B Freedman
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
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Yang F, Wang GD, Huang R, Ma H, Zhao XW. Ligament augmentation reconstruction system artificial ligaments in patellar tendon reconstruction - a chronic patellar tendon rupture after multiple operations: A case report. World J Clin Cases 2020; 8:831-837. [PMID: 32149068 PMCID: PMC7052563 DOI: 10.12998/wjcc.v8.i4.831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/01/2020] [Accepted: 02/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patellar tendon rupture is a rare disease, and reports regarding patellar tendon reconstruction with ligament augmentation reconstruction system (LARS) ligaments are limited, with only three reports available in the literature. LARS ligaments are made of polyethylene terephthalate and have been certified as a more favorable option than other tendon transplants. To our knowledge, this is the first report of patellar tendon reconstruction with LARS for suture fixation due to poor quality of the tendon after multiple operations to enable early mobilization and quick rehabilitation.
CASE SUMMARY A 65-year-old woman had limited ability in extending her leg and an inability to perform a straight leg raise after multiple operations due to patella fracture. The patient underwent patellar tendon reconstruction with LARS artificial ligaments. After 12 mo of follow-up, the patient was able to perform a straight leg raise, and the incision healed well without complications. The Lysholm score was 95 and the range of motion of the knee was 0-130°.
CONCLUSION This study revealed that patellar tendon reconstruction with LARS artificial ligaments is possible in a patient with a patellar tendon rupture who required rapid postoperative recovery.
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Affiliation(s)
- Fei Yang
- School of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Guo-Dong Wang
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Rong Huang
- School of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Hui Ma
- School of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Xiao-Wei Zhao
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
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Yang Y, Wang Y, Wang X, Gu S, Wang H, Wu L. [Effectiveness of patellar tendon reconstruction with LARS artificial ligament for old patellar tendon rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:542-545. [PMID: 31090345 DOI: 10.7507/1002-1892.201809082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of patellar tendon reconstruction by using LARS artificial ligament in treatment of old patellar tendon rupture. Methods A clinical data of 12 patients with old patellar ligament ruptures, who met the inclusive criteria and reconstructed with LARS artificial ligament between December 2011 and December 2017, was retrospectively analyzed. There were 8 males and 4 females with an average age of 33.5 years (range, 18-55 years). The cause of injury included traffic accident injury in 4 cases, sport injury in 5 cases, and violent injury in 3 cases. There were 5 cases in the left knee and 7 cases in the right knee. The disease duration was 2-12 weeks (mean, 2.5 weeks). The preoperative Lysholm score and Kujala score were 43.2±3.2 and 43.9±2.6, respectively. The knee range of motion was (106.5±14.7)°. The thigh circumference which was measured at 10 cm above the upper end of the patella was (40.92±1.93) cm. There were 4 cases of patellar ligament body rupture, 1 case of patella distal pola rupture, and 7 cases of tibial tuberosity attachment rupture. Preoperative Caton-Deschamps index was 1.47±0.13. Results All patients were followed up 12-30 months (mean, 20.5 months). All incisions healed by first intention. And no complication such as infection, recurrent rupture, and neurovascular injury occurred. At 1 year after operation, the knee range of motion was (131.0±10.2)°, Lysholm score was 87.4±2.4, Kujala score was 88.3±4.8, the thigh circumference which was measured at 10 cm above the upper end of the patella was (42.58±1.93) cm; all showing significant differences when compared with preoperative values ( P<0.05). The effectiveness results were excellent in 9 cases and good in 3 cases according to the Insall evaluation criteria. The Caton-Deschamps index was 1.09±0.11, which was significantly lower than preoperative one ( t=8.155, P=0.000). Conclusion Patellar tendon reconstruction with LARS artificial ligament is an effective method for the old patellar ligament rupture, which can effectively repair the knee extension device and restore knee function.
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Affiliation(s)
- Yan Yang
- Department of Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Yanfeng Wang
- Department of Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001,
| | - Xinxian Wang
- Department of Ultrasound, Jinqiu Hospital of Liaoning Province, Shenyang Liaoning, 110015, P.R.China
| | - Shizhong Gu
- Department of Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Hanning Wang
- Department of Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Liying Wu
- Department of Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
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Lang SD, Irons MRH, Gilmer BB. Repair of Patellar Tendon Avulsion from the Tibial Tubercle: Case Report. J Orthop Case Rep 2019; 9:26-30. [PMID: 32547998 PMCID: PMC7276613 DOI: 10.13107/jocr.2250-0685.1518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Pre-existing conditions and surgical interventions, such as those associated with Osgood-Schlatter disease, can lead to atypical patellar tendon ruptures. These cases can present irregularly and be challenging to diagnose. Patellar tendon rupture from the tibial tubercle insertion region is a rare, and currently undocumented condition, requiring surgical intervention to restore knee joint functionality for daily activities. This presentation requires a unique treatment approach, as standard reconstruction techniques do not apply. Case Report: A 65-year-old Caucasian male, with a remote history of gout and surgical intervention for symptomatic Osgood-Schlatter disease, suffered sudden hyperflexion with eccentric contraction of the right knee while hiking. The patient presented with massive right knee effusion and significant tenderness over the tibial tubercle, with an inability to extend the knee. After radiographs were inconclusive, magnetic resonance imaging was performed showing a tear of the medial aspect of the distal patellar tendon. Conclusion: Surgical intervention for Osgood-Schlatter disease can be a potential risk factor for patellar tendon rupture from the tibial tubercle. Since a variety of surgical interventions for symptomatic Osgood-Schlatter disease exist, it is important to consider the long-term effects and counsel patients on the associated risks of the procedures. Initial diagnosis of patellar tendon rupture can be surprisingly challenging when the presentation is atypical. Attention to detail during physical examination and evaluation of imaging is a necessity for early detection and treatment, which can afford excellent functional outcomes
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Affiliation(s)
- Sarah Dawn Lang
- Department of Orthopaedics, Mammoth Orthopedic Institute, PO Box 660, Mammoth Lakes, California 93546, U.S.A
| | - Matthew Robert Henry Irons
- Department of Orthopaedics, Mammoth Orthopedic Institute, PO Box 660, Mammoth Lakes, California 93546, U.S.A
| | - Brian Brandon Gilmer
- Department of Orthopaedics, Mammoth Orthopedic Institute, PO Box 660, Mammoth Lakes, California 93546, U.S.A
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Iterative Rupture of the Patellar Tendon: A Case Report of an Original Technique for Revision Reconstruction Using an Adjustable Loop and an Artificial Ligament. Case Rep Orthop 2018; 2018:6107287. [PMID: 30310703 PMCID: PMC6166387 DOI: 10.1155/2018/6107287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/29/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022] Open
Abstract
Chronic rupture of the patellar tendon is a severe injury that leads to dramatic functional consequences including lack of extension and walking difficulty. Surgery is the gold standard to treat this type of injury, but revision reconstructions are problematic because an ipsilateral graft was often harvested for the initial surgery. Because fibrotic tissues on the patellar tendon need to be debrided, another graft must be added to reinforce the tendon. We reported the case of a former semiprofessional handball player, a 29-year-old man who presented an iterative rupture with the fracture of the transverse patellar tunnel 6 months after reconstruction using a semitendinosus graft and suture repair. We performed revision reconstruction surgery using an artificial ligament placed between the extensor mechanism and the tibia for extra-articular reinforcement to maintain extensor mechanism continuity. Two adjustable loops were also used to repair the patellar tendon tear. At 2-year follow-up, the patient was able to resume the practice of handball at a competitive level with good clinical and functional results. This technique can therefore be used as a salvage procedure for chronic iterative rupture of the patellar tendon.
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