Treatment of a Neglected Patellar Tendon Rupture with a Modified Surgical Technique: Ipsilateral Semitendinosus Autograft Reconstruction with Suture Tape Augmentation. Case Rep Orthop. 2018;2018:2037638. [PMID: 30073104 PMCID: PMC6057304 DOI: 10.1155/2018/2037638]

Management of Chronic Patella Tendon Tear with Heterotopic Ossifications: A Case Report and Pictorial Review of Various Techniques in Contemporary Practice

Purpose

To review reliable techniques for reconstructing or repairing chronic patella tendon tears and describe the unique case report of chronic patellar tendon tear with heterotopic ossification (HO).

Case description

A 47-year-old male presented with chronic patellar tendon tears with HO, resulting in an inability to extend the right knee fully. Krackow suture repair augmented by autograft semitendinosus and gracilis was employed after debriding intra-substance patella tendon HO and fibrotic tissue. The repair was augmented using a method described by Chen et al. Postoperative recovery was uneventful, and the patient demonstrated an excellent Knee Society Score (86/100) at 6 months of follow-up. Proximal migration of the patella, poor tissue quality, scar tissue formation, and quadriceps atrophy pose unique challenges in managing chronic patellar tendon tears.

Conclusion

HO increased the probability of patella baja after the reconstruction. To alleviate that, precise pre-op planning, careful method selection, and proper execution of the selected method are very important. A comprehensive review of 14 different methodologies for managing chronic patellar tendon tears, comprising eight case series and six case reports, was conducted. The selection of an appropriate technique should be based on individual patient characteristics, resource availability, and the surgeon's expertise.

Reconstructing a Patellar Tendon Rupture Neglected for 14 Years When Anatomic Restoration Is Not Possible: A Case Report

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.

Clinical Outcomes are Similar Between Graft Types Used in Chronic Patellar Tendon Reconstruction: A Systematic Review

Purpose

To compare clinical outcomes between graft types and techniques used to repair chronic patellar tendon injuries to help surgeons make evidence-based decisions.

Methods

Medline, Embase, and Cochrane libraries were searched through January 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Inclusion criteria were surgical treatment of chronic patellar tendon injury (defined as >6 weeks old), article available in English, and human subjects, minimum 1-year follow-up, and level of evidence I-IV. Studies describing chronic patellar tendon ruptures in the setting of total knee arthroplasty were excluded. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools for case reports and case series.

Results

A total of 642 studies were identified through the initial search with 9 studies meeting all inclusion criteria. All studies included were case series encompassing 96 patients with follow-up ranging from 21 months to 7.2 years. Reconstruction techniques included the use of semitendinosus and/or gracilis tendon(s), Achilles tendon, bone-patellar tendon-bone (BTB), or direct repair. The most common graft choice was semitendinosus and/or gracilis tendon(s). Each reconstruction method yielded improvement in respect to range of motion (ROM), extensor lag, quadriceps strength, and patient-reported outcome measures (PROMs). Commonly reported complications were pain and numbness with only one reported instance of graft failure.

Conclusions

In this study, we found that all reconstructive methods described in the literature can produce satisfactory outcomes with improved function, strength, and minimal complications after chronic patellar tendon ruptures. Because of study heterogeneity and low levels of evidence, consensus cannot be reached on a single superior reconstruction method.

Level of Evidence

Level IV, systematic review of level IV studies.

Staged patellar tendon reconstruction using doubled bone-patellar tendon-bone allograft for infected patellar tendon rupture: a rare case report of three years follow-up

BACKGROUND

Patellar tendon rupture is a relatively rare injury that usually requires surgical treatment. The optimal therapeutic strategy is still controversial, especially when either concomitant patellar tendon infection or soft tissue infection surrounds the patellar tendon. Until recently, most reported reconstruction methods are extensive and difficult to apply because of the poor condition of the soft tissue surrounding the patellar tendon.

CASE PRESENTATION

A 19-year-old male patient presented to our clinic three weeks following a motorcycle accident. There was a 5 x 4 cm sized skin defect with soft tissue infection below the inferior pole of patella. We performed a staged patellar tendon reconstruction using a doubled bone-patellar tendon-bone allograft (BPTB) to the infected patellar tendon rupture, following local random fasciocutaneous flap and split-thickness skin graft. Three months following surgery, the patient was able to perform an active knee motion with no extension lag and excellent clinical functional result.

DISCUSSION AND CONCLUSIONS

Our technique introduced in this specific case is a relatively simple method to reconstruct chronic patellar tendon defects with limited incision exposing only the patellar tendon areas. We expect it can be less invasively performed on patients who have a soft tissue problem and cannot have extensive surgery.

Distal Patellar Tendon SpeedBridge Repair

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.

Patellar Tendon Reconstruction for a Chronic Extensor Mechanism Deficit Using an Achilles Tendon Allograft With Hamstring Autograft and Suture Augmentation

Patellar tendon ruptures are the third most common injury to the extensor mechanism. These injuries are debilitating to the patient, and delays in treatment can present a challenge to the treating surgeon. Chronic patellar tendon injuries are rare and are more difficult to manage given proximal patellar retraction, scarring, and atrophy of surrounding tissues. There is no consensus on the optimal approach for treatment, and numerous reconstruction techniques have been described using a variety of graft choices and fixation methods. We describe our surgical technique for a 3-fold reconstruction of a chronic patellar tendon rupture using an Achilles tendon allograft augmented with a vascularized ipsilateral hamstring tendon autograft and additional FiberTape augmentation. The aim of this procedure is to restore patellar height and prevent extensor lag.

Ligament augmentation reconstruction system artificial ligaments in patellar tendon reconstruction - a chronic patellar tendon rupture after multiple operations: A case report

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.

Reconstruction of Neglected Patellar Tendon Rupture using Tendoachilles' Allograft with Transosseous Tunnels: A Case Report

Introduction:

Neglected patellar tendon ruptures are uncommon. They are challenging due to the proximal migration of patella and soft-tissue contractures. They are usually managed with autografts or allografts with or without synthetic augmentation, and fixation is done using metallic implants.

Case Report:

A 59-year-old farmer presented with an inability to straighten his knee for 6 months after sustaining a cut lacerated wound with a sickle. He was diagnosed with a patellar tendon rupture. Tendoachilles’ allograft reconstruction was done by creating transosseous tunnels in the patella and tibial tuberosity with a figure of 8 con figurations of the final construct. Synthetic augmentation and metallic implants were not used. Excellent clinical and radiological results were achieved at 3 years’ follow-up.

Conclusion:

Chronic patellar tendon ruptures can be managed using allograft without the need for synthetic augmentation or fixation with implants. This gives excellent clinical and radiological results.

Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages

Patellar tendon rupture is an uncommon but disabling lesion. It usually occurs in men younger than 40 years, through direct or indirect trauma. Obtaining satisfactory results with treatment of chronic injuries and re-ruptures in which the patella retracts owing to quadriceps contraction is a challenge. This is of major concern especially in cases in which the patella cannot be positioned in its anatomic position when distal traction is performed. In these cases, V-Y stretching of the quadriceps can be performed in an attempt to perform reconstruction in 1 stage. Instead, a 2-stage procedure can be chosen, in which the first stage relies on patellar trans-skeletal traction to achieve distalization of the patella. In 1981, a technique for the treatment of chronic injuries of the patellar tendon in 2 stages was described. In that procedure, the first stage consisted of transpatellar traction and the second stage was tendon-tendon suturing with fascia lata reinforcement. We describe a surgical technique performed in 2 stages; in the first stage, trans-skeletal traction is performed, and in the second stage, the technique of Kelikian et al. with our modification is performed. This technique is used in patients with chronic rupture of the patellar tendon associated with a high patella with nonreducible quadriceps shortening.

Patellar Tendon Reconstruction Using Hamstring Tendon and Adjustable Suspensory Cortical Fixation

Chronic patellar tendon rupture is a rare injury; extensor mechanism impairment leads to great disability in daily life. The delayed diagnosis and reconstruction of chronic patellar tendon ruptures are technically challenging. Numerous surgical procedures have been described with bone-tendon-bone graft, hamstring graft, artificial ligament, and allograft. We describe safe, reproducible anatomic reconstruction of the patellar tendon using hamstring tendon and adjustable suspensory fixation. After harvesting of the hamstrings, the graft is prepared with 2 adjustable suspensory fixation devices. Then, a complete tibial tunnel and a patellar tunnel with a socket are drilled with the appropriate diameter, and the graft is pulled through the tunnels. Finally, the suspensory fixation devices on the tibial and patellar sides are tensioned. The aim of this procedure is to obtain complete mobility of the knee, using a procedure similar to anterior cruciate ligament reconstruction in graft preparation.

Intra-operative patellar fracture during chronic patellar tendon rupture reconstruction: salvage and prophylactic modified techniques

Management of chronic neglected patellar tendon rupture represents a challenging condition for the orthopedic surgeons to deal with due to many factors such as quadriceps muscle atrophy, superior migration of the patella, e.g., patella alta, peri-patellar adhesions and patellar tendon atrophy. Such difficulties might be further complicated by intra-operative patellar fracture during patellar tendon reconstruction. In the current article, the authors report (1) a salvage procedure for such devastating intra-operative complication, based on bypassing the patella and gaining the advantage of the quadriceps tendon for structural and functional restoration of the knee extensor mechanism, and (2) prophylactically a technical modification of patellar tendon reconstruction guarding against such inadvertent patellar fracture.

[Patellar tendon ruptures : Internal bracing and augmentation technique]

OBJECTIVE

To report a surgical technique for the treatment of patellar tendon ruptures augmented with an internal brace suture tape.

INDICATIONS

Acute patellar tendon ruptures, fractures of the distal patellar pole, chronic insufficiency of the patellar tendon or revision surgery for failed repairs.

CONTRAINDICATIONS

Severe damage to the surrounding soft tissue. Local infection. Life-threatening conditions.

SURGICAL TECHNIQUE

Direct longitudinal anterior approach to the patellar tendon. Two parallel transosseous bone tunnels are drilled in the patella and tibial tuberosity with a 2.4 mm drill bit. Two separate FiberTapes® (Arthrex, Naples, FL; USA) are shuttled through the proximal and distal bone tunnels around the tendon in "X" and "O" type configuration. Patellar height is reestablished under fluoroscopic control and both FiberTapes are tied down. Both tendon ends are debrided and readapted with absorbable sutures.

POSTOPERATIVE MANAGEMENT

Passive motion exercise to 90° of flexion from day 1. Partial load to 20 kg of body weight with knee in locked full extension brace during first 2 weeks. Isometric exercises from week 3. Passive flexion to 110° from week 4 (adapted to pain). Free active range of motion and weight bearing from week 7.

RESULTS

In more than 10 years of clinical application, positive results were continuously found in acute as well as chronic patellar tendon ruptures. These results are consistent with those in the current literature.