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Kim WT, Kao D, O’Connell R, Patel NK, Vap A. Clinical Outcomes are Similar Between Graft Types Used in Chronic Patellar Tendon Reconstruction: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1861-e1872. [PMID: 36312722 PMCID: PMC9596887 DOI: 10.1016/j.asmr.2022.06.007] [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: 03/07/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022] Open
Abstract
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.
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Achilles Tendon-Bone Allograft is Advantageous for Chronic Patellar Tendon Ruptures Using a Modified Fixation Technique. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adisthanaya S, Astawa P, Aryana IGNW, Febyan. Semitendinosus and Gracilis Autograft for Neglected Patellar Tendon Rupture: A Surgical Reconstruction. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Neglected patellar tendon rupture is an extremely rare case among orthopedic injuries that severely compromises the function of the extensor mechanism of the knee. Therefore, a prompt and accurate diagnosis of a ruptured patellar tendon are a key to efficacious management, because a treatment delay is often associated with unsatisfactory functional outcomes.
CASE PRESENTATION: We report the case of an adult male patient with traumatic patellar tendon rupture after 9 months of a motorcycle accident. The patient underwent reconstruction surgery using semitendinosus and gracilis tendon augmentation. This procedure restores the anatomical position of the patella and prevents extensor lag. At a 3-month follow-up, a full recovery of the structure and function of the extensor mechanism was perceived. The patient could return to normal daily activities following rehabilitation protocol.
CONCLUSION: Semitendinosus and gracilis tendon autograft is the technique of choice to be applied in the surgical reconstruction of neglected patellar tendon rupture.
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Complication after the reconstruction of the old patellar tendon rupture. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200914136n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Chronic patellar tendon rupture (PTR) occurs rarely; its frequency and prevalence are unknown. There are very little data on the late patellar tendon reconstruction in rheumatoid arthritis and its complications. Case report. We presented a surgical repair of a PTR with early postoperative rupture of the contralateral patellar tendon for a 21-year-old woman with a past medical history of juvenile rheumatoid arthritis (treated with corticosteroids) who sustained initial injury 11 months prior to the presentation. The contralateral side was used for autograft harvesting. We used bone-tendon-bone (BTB) autograft and allografts followed by double-wire loop reinforcement and immediate postoperative mobilization. The patient was followed for 2 years, and the function of both knees was re-stored completely, with a full active range of motion. In this case, reconstruction of an 11-month-old chronic PTR (with complete resorption of the tendon and completely separated infrapatellar pads, complicated by the contralateral PTR) with BTB autograft and allografts and double wire loop reinforcement gave an excellent functional result. Two years after the surgical treatment, the extensor function of both knees was completely restored with a full range of movements. The patient reported satisfying outcomes and was able to return to all pre-injury activities without the assistance of orthopedic devices. Conclusion. This case report highlights the importance of the early diagnosis and describes operative techniques used in chronic PTR repair and treatments of the early postoperative complications such as rupture of the contralateral tendon.
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Mao Y, Sun W, Xiong Y, Li Q, Chen G, Tang X, Fu W, Li J. [Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:160-165. [PMID: 33624467 DOI: 10.7507/1002-1892.202010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects. Methods The clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed. The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts, in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella, and 1 bone tunnel was created beneath the tibial tuberosity. There were 8 males and 3 females with an average age of 30.1 years (range, 10-61 years). The average interval from the primary injury to the operation was 9.5 months (range, 2-36 months). According to Yousef classification, there were 7 cases of type A2, 3 cases of type B2, and 1 case of type C2. The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm (range, 2.7-7.1 cm). Subjective function scores [including International Knee Documentation Committee (IKDC) subjective score, Tegner activity level, and Lysholm score] were evaluated before operation and at last follow-up. The loss of knee extension, Caton index, and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured. Results All patients were followed up 24-66 months (mean, 34.2 months). All incisions were primary healing, and there were no complications such as wound infection, venous thrombosis of the lower extremities, stiffness of the knee joint, graft failure, neurovascular injury, etc. No second revision surgery was performed during the follow-up. At last follow-up, the subjective function scores (IKDC subjective score, Tegner activity level, Lysholm score), loss of knee extension, thigh circumference difference, and Caton index were significantly improved when compared with those before operation ( P<0.05). Two patients still had patella alta, with Caton indexes of 1.29 and 1.32, respectively. Conclusion In the treatment of chronic patellar tendon ruptures and defects, the modified patellar tendon reconstruction using hamstring autograft can significantly improve the postoperative knee function, restore the normal range of knee extension, enhance the extensor and correct the patella alta.
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Weihao Sun
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Qi Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Gang Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Choi HS, Jang BW, Chun DI, Kim YB, Seo GW, Hwang J, Lee BI. 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. J Exp Orthop 2021; 8:13. [PMID: 33599861 PMCID: PMC7892650 DOI: 10.1186/s40634-021-00334-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Hyung Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea.
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jinyeong Hwang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Byung Ill Lee
- Department of Orthopedic Surgery, Smarton Hospital, Bucheon, Korea
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Technique for Fixation of Semitendinosus to the Patella in Patellar Tendon Reconstruction. Arthrosc Tech 2020; 9:e1943-e1949. [PMID: 33381404 PMCID: PMC7768288 DOI: 10.1016/j.eats.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/28/2020] [Indexed: 02/03/2023] Open
Abstract
Chronic patellar tendon injuries are rare yet challenging to treat. Timing of surgery and graft choices are debatable. Many techniques and methods of fixation have been described with pros and cons. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique. In this Technical Note, we use distally based semitendinosus (ST) looped over 2 ETHIBOND sutures. The ETHIBOND is passed through 2 vertical tunnels in the patella and retrieved proximally, docking the ST in a blind tunnel created in the lower pole of the patella. The whip-stitched free ST end is passed through a tunnel behind the tibial tubercle and sutured back to its base. A polyester tape is used to augment the repair in a circumferential manner. Postoperatively full weight bearing is allowed as tolerated in a hinged knee brace locked in extension with only passive range of motion of 0-90° allowed for 6 weeks.
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Akpinar B, Baron S, Alaia MJ, Jazrawi LM. Clinical and Biomechanical Outcomes following Knee Extensor Mechanism Reconstruction. Arthrosc Sports Med Rehabil 2020; 2:e553-e561. [PMID: 33134994 PMCID: PMC7588626 DOI: 10.1016/j.asmr.2020.07.001] [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: 11/24/2019] [Accepted: 07/01/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR). Methods Patients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset. Results From 2011 to 2018, 12 patients (12 knees, 10 male, 5 right, mean age: 54.3 ± standard deviation: 15.2 years) with KEM injuries requiring tendon reconstruction with a 1-year minimum follow up were identified. Postoperative follow-up was 42.6 months (range: 12.0-93.0 months). Procedures included patellar (7) and quadriceps tendon reconstruction (5). Postoperative versus preoperative Tegner Activity Scale scores demonstrated significant improvement (3.5 ± 2.5 vs 1.5 ± 1.2, n = 8, P = .05). Postoperative versus preoperative Kujala scores significantly improved (70.3 ± 11.7 vs 43.6 ± 15.7, n = 8, P = .010). There was significant improvement in preoperative to postoperative KEMR extension lag (29.4 ± 22.2° vs 0.83 ± 1.9°, P = .002). Clinically, there was no difference in passive range of motion between the operative and contralateral knee. BioDex testing demonstrated decreased maximum work generated from the operative versus contralateral knee at slow (70.4 ± 30.4 Joules vs 101.9 ± 40.6 J; P = .028), intermediate (52.0 ± 45.4 J vs 69.8 ± 63.7 J; P = .038), and fast (43.8 ± 41.7 J vs 57.5 ± 53.8 J; P = .050) speeds. Range of motion was less in the operative versus contralateral knee at all speeds: P = .011, .038, and .024. The average peak torque generated per body weight was smaller in the operative versus contralateral knee at slow speed (P = .038). Conclusions Patients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively. Level of Evidence Therapeutic Case Series, Level IV.
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Affiliation(s)
- Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
| | - Samuel Baron
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
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Patellar Tendon Reconstruction for a Chronic Extensor Mechanism Deficit Using an Achilles Tendon Allograft With Hamstring Autograft and Suture Augmentation. Arthrosc Tech 2020; 9:e469-e475. [PMID: 32368466 PMCID: PMC7189117 DOI: 10.1016/j.eats.2019.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/22/2019] [Indexed: 02/03/2023] Open
Abstract
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.
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Kandeel AAMA, El-Saeady AI, Eid TAS. Intra-operative patellar fracture during chronic patellar tendon rupture reconstruction: salvage and prophylactic modified techniques. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1549-1557. [PMID: 31154509 DOI: 10.1007/s00590-019-02459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022]
Abstract
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.
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Aharram S, Mounir Y, Derfoufi A, Kharraji A, Amghar J, Benhamou M, Abdessamad L, Walid B, Mohammed S, Agoumi O, Daoudi A. [Patellar tendon rupture with distal closed fracture of the ipsilateral femur]. Pan Afr Med J 2019; 32:149. [PMID: 31303920 PMCID: PMC6607324 DOI: 10.11604/pamj.2019.32.149.17723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/16/2019] [Indexed: 11/14/2022] Open
Abstract
We here report the case of a 45-year old patient who had injured his right knee because of a road accident. The patient had right comminuted supracondylar femur fracture and ipsilateral patellar tendon rupture. This association is exceptional and no case has been reported in the literature. Targeted clinical and radiological diagnostic tests followed by early and suitable management based on internal osteosynthesis and suitable early functional rehabilitation enabled good long term outcome.
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Affiliation(s)
- Soufiane Aharram
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Yahyaoui Mounir
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Abdelhafid Derfoufi
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Abdessamad Kharraji
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Jawad Amghar
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Mohammed Benhamou
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Lamhaoui Abdessamad
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Bouziane Walid
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Sadougui Mohammed
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Omar Agoumi
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
| | - Abdelkarim Daoudi
- Service de Traumatologie-orthopédie, CHU Mohammed VI, Faculté de Médecine et de Pharmacie d'Oujda, Oujda, Maroc
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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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Fiquet C, White N, Gaillard R, Servien E, Neyret P, Lustig S. Partial extensor mechanism allograft reconstruction for chronic patellar tendon disruption shows superior outcomes in native knees when compared to same technique following total arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 42:2591-2599. [PMID: 30135985 DOI: 10.1007/s00264-018-4119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Chronic patellar tendon disruption occurs mostly after total knee arthroplasty, and is a challenging complication to treat. We have previously described an original technique for reconstruction using extensor mechanism allograft. The goal of this study was to assess the results of this technique in TKA and native knees. METHODS An observational, single centre, retrospective study was conducted. Nine patients in the TKA group and eight in the native knee group were included, all treated for chronic PT rupture. The operative technique included fresh-frozen allograft, in which the patella was fashioned into an hourglass shape and press-fit in a corresponding groove in the native patella. The primary outcome was failure of the graft defined by a residual extensor lag > 10°. RESULTS The mean age was 68 in the TKA group and 51 in the native group. The minimum follow-up was 24 months and the mean follow-up respectively 42 and 39 months. 33% of allografts failed in the TKA group where none failed in the native knee group, with a mean extension lag of 12.2° (0-30) and 1.25° (0-5), respectively. All but the three failures presented with an extension lag < 10°. Four cases of patellar bone block distal migration, less than 1 cm, were recorded in the native knee group without clinical repercussion. CONCLUSIONS The results of this original technique in the setting of chronic PT rupture were excellent for native knees at a minimum follow-up of 24 months. However, results were less satisfactory in the TKA group, due to the substantial rate of failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Charles Fiquet
- Centre Albert Trillat, Service de Chirurgie Orthopédique, Hôpital Universitaire Lyon Nord, Lyon, France.
| | - Nathan White
- Centre Albert Trillat, Service de Chirurgie Orthopédique, Hôpital Universitaire Lyon Nord, Lyon, France
| | - Romain Gaillard
- Centre Albert Trillat, Service de Chirurgie Orthopédique, Hôpital Universitaire Lyon Nord, Lyon, France
| | - Elvire Servien
- Centre Albert Trillat, Service de Chirurgie Orthopédique, Hôpital Universitaire Lyon Nord, Lyon, France
| | - Philippe Neyret
- Centre Albert Trillat, Service de Chirurgie Orthopédique, Hôpital Universitaire Lyon Nord, Lyon, France
| | - Sébastien Lustig
- Centre Albert Trillat, Service de Chirurgie Orthopédique, Hôpital Universitaire Lyon Nord, Lyon, France
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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] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/07/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022] Open
Abstract
Patellar tendon ruptures are rare, but debilitating injuries are typically seen in young active males in the third and fourth decades of life. They can occur as a single acute injury or from repetitive microtrauma weakening the tendon. Patients typically present complaining of knee pain, swelling, and an inability to perform a straight leg raise. Most conventionally, these injuries are classified as acute (less than two weeks) or chronic (greater than two weeks) based upon the timing of presentation. In patients with patellar tendon ruptures and inability to perform a straight leg raise, patellar tendon repair is most often recommended. A subset of patients with chronic patellar tendon ruptures, however, presents several months after their initial injuries. These neglected patella tendon ruptures present a particularly challenging clinical scenario in which primary repair is often difficult or not possible. This case report describes a modification to an existing surgical technique for reconstructing the patellar tendon using an ipsilateral semitendinosus tendon autograft with suture tape augmentation.
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Temponi EF, Camelo N, Tuteja S, Thaunat M, Daggett M, Fayard JM, de Carvalho Júnior LH, Sonnery-Cottet B. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc 2017; 25:2468-2473. [PMID: 26713328 DOI: 10.1007/s00167-015-3951-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the clinical and functional outcome following the reconstruction of chronic patellar tendon ruptures using the contralateral bone-tendon-bone (BTB) autograft. METHODS The records of seven patients who underwent reconstruction of chronic patellar tendon rupture with contralateral patellar BTB were retrospectively reviewed. Chronic tears were defined as a minimum of 3 months from injury to initial clinical evaluation. Clinical assessments included range of motion of the knee, Tegner, Lysholm and International Knee Documentation Committee (IKDC) score and a radiographic analysis of patellar height (Caton-Deschamps index). Postoperative complications and quadriceps strength at last follow-up were reported. RESULTS The mean age of the patients undergoing surgery was 33 (±10.5) years with a mean follow-up of 41.3 (±29.7) months. Reconstruction surgery was performed at an average of 16 months (3-60 months) after the injury. 86 % of the patients had a normal patella height with mean of patellar height of 1.5 (±0.2) in preoperative radiographs and of 1.2 (±0.07) on postoperative evaluation (p = 0.0136). The mean IKDC was 45.5 (±10.8) before surgery and 64.5 (±12.4) at the last follow-up (p = 0.0001), and Lysholm score was 45.4 (±11.3) and 79 (±11.8), respectively (p = 0.0001). The median Tegner activity scale preinjury was 6 (range 5-7), preoperatively was 1 (range 1-2) and 4 (range 2-5) postoperatively (p = 0.0001). All patients had quadriceps wasting with a difference in thigh girth between the injured side and healthy side of 3.6 ± 0.7 cm (ns). No surgical complications were encountered. CONCLUSIONS In this limited cohort, surgical reconstruction of chronic patellar tendon ruptures using contralateral bone-tendon-bone graft was a safe and viable option that improves clinical and functional outcomes compared to presurgical function. However, despite the restoration of a normal patellar height, function did not return to preinjury level.
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Affiliation(s)
- Eduardo Frois Temponi
- Hospital Madre Teresa, Av. Raja Gabáglia 1002, Gutierrez, Belo Horizonte, Minas Gerais, 30430-142, Brazil.
| | - Nuno Camelo
- Centre Orthopedic Santy, FIFA Medical Center of Excelence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Hôpital Privé Jean Mermoz, Lyon, France
| | - Sanesh Tuteja
- Centre Orthopedic Santy, FIFA Medical Center of Excelence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopedic Santy, FIFA Medical Center of Excelence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jean Marie Fayard
- Centre Orthopedic Santy, FIFA Medical Center of Excelence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Bertrand Sonnery-Cottet
- Centre Orthopedic Santy, FIFA Medical Center of Excelence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Hôpital Privé Jean Mermoz, Lyon, France
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Basu SK, Bain J, Majumdar BK, Chattopadhyay D, Baitalik D, Dewangan YK, Bhattacharya D, Rakshit P, Gupta V, Kumar A, Haldar RN. From wheelchair to walking: First case report of post-electrical burn destruction of patellar ligament with its one-stage reconstruction and restoration of function. Indian J Plast Surg 2017; 50:100-103. [PMID: 28615820 PMCID: PMC5469217 DOI: 10.4103/ijps.ijps_200_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Electrical burn injury causing bilateral patellar ligament destruction leading to complete loss of knee extension is a very rare injury. In such situation, surgical repair or reconstruction of the patellar ligament becomes necessary to restore knee functions. Here, we present such a case of an 8-year-old boy, whose both patellar ligaments were destroyed throughout its length due to high-voltage electrical injury. His left knee joint cavity was exposed and grossly infected, but the right knee joint cavity was apparently intact. The right-sided patellar ligament was reconstructed with an ipsilateral and looped semitendinosus tendon graft and covered with a medial gastrocnemius musculocutaneous flap. The patient had an uneventful recovery, and full range of motion in the right knee joint along with good bipedal locomotion was achieved successfully.
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Affiliation(s)
- Sandip Kanti Basu
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Jayanta Bain
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bijay Kumar Majumdar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Debarati Chattopadhyay
- Department Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debasis Baitalik
- Department of Plastic Surgery, M.R. Bangur Hospital, Kolkata, West Bengal, India
| | | | | | - Pritha Rakshit
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Vivek Gupta
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Ashwani Kumar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rathindra Nath Haldar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Surgical Treatment for Failure of Repair of Patellar and Quadriceps Tendon Rupture With Ipsilateral Hamstring Tendon Graft. Sports Med Arthrosc Rev 2017; 25:51-55. [PMID: 28045874 DOI: 10.1097/jsa.0000000000000138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patellar tunnel openings with sutures. The details of the technique are fully described. Autologous ipsilateral hamstring tendon grafts provide a secure sound means to manage these challenging injuries.
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19
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Maffulli N, Buono AD, Oliva F. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: surgical technique. Muscles Ligaments Tendons J 2017; 7:157-162. [PMID: 28717624 DOI: 10.11138/mltj/2017.7.1.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patellar tendon chronic ruptures are more debated to manage that acute injuries as the patella tends to retract proximally (after 2 weeks), and surrounding soft tissues may make the repair more complicate. PURPOSE We propose a novel technique in which the patellar tendon is reconstructed using ipsilateral hamstring tendons. This surgical procedure implies to drill a single tunnel through the patella and another through the tibia to reduce the risk of bony breakage. In addition, the tendon is secured to the bone, at the tunnel exit points, by periostium sutures without requiring any additional surgery for hardware removal. METHODS We assessed 19 patients (16 men and 3 women) who underwent PT reconstruction at an average of 5.8 years (range, 4 to 7.8 years, SD: 3.5) from the index surgery. The mean age at surgery was 46 ± 9.2 years (range, 38-59 years). RESULTS All patients had a complete tear of the patellar tendon. CONCLUSIONS The main indication for this procedure is the reconstruction of the PT in patients with chronic rupture (>6 weeks) in which the tendon gap is greater than 2 centimeters and the scar tissues and degenerated tendon ends do not allow to juxtapose the tendon stumps to each other. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, London, UK
| | - Angelo Del Buono
- Department of Orthopedic and Trauma Surgery, Fidenza Hospital, Fidenza, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
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20
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Spoliti M, Giai Via A, Padulo J, Oliva F, Del Buono A, Maffulli N. Surgical repair of chronic patellar tendon rupture in total knee replacement with ipsilateral hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2016; 24:3183-3190. [PMID: 25423873 DOI: 10.1007/s00167-014-3448-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 10/30/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE Patellar tendon rupture is a serious complication of total knee arthroplasty (TKA). Its reconstruction in patients with chronic ruptures is technically demanding. This article reports the results of surgical reconstruction of neglected patellar tendon rupture in TKA using autologous hamstring tendons. METHODS Nine TKA patients (six women and three men) (mean age at index surgery 68 years) with chronic patellar tendon tears underwent reconstruction with ipsilateral hamstrings tendon, leaving the distal insertion in situ. The clinical diagnosis was supported by imaging (anterior-posterior and 30° flexion lateral radiographs). Insall-Salvati index, range of motion, and leg extension test were recorded preoperatively and at last follow-up. The modified Cincinnati rating system and the Kujala score were administered. The patients sustained the patellar tendon tear an average of 8 weeks before the procedure. RESULTS At final follow-up of 4 years (range 2-8 years), the median of extension lag was 5° (range 0°-15°; DS = 5). The median of post-operative Insall-Salvati index was 1.4 (range 1.3-1.8; SD = 0.15; p = 0.002) compared to the preoperative index of 1.7 (range 1.5-2.2; SD = 0.23). The mean modified Cincinnati and Kujala scores significantly increased compared with the preoperative ones (p < 0.01). At final follow-up, all patients were able to walk without brace or aids, and they were satisfied with the procedure. CONCLUSION Based on our retrospective study of nine patients, reconstruction of neglected patellar tendon rupture in TKA with autologous hamstring tendons is feasible and safe, and provides good functional recovery. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Marco Spoliti
- Department of Orthopaedics and Traumatology, San Camillo-Forlanini Hospital, Piazza C. Forlanini 1, Rome, Italy
| | - Alessio Giai Via
- Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Viale Oxford 81, 00133, Rome, Italy
| | - Johnny Padulo
- University e-Campus, Novedrate, Italy.,Tunisian Research Laboratory 'Sports Performance Optimization', National Center of Medicine and Science in Sport, Tunis, Tunisia
| | - Francesco Oliva
- Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Viale Oxford 81, 00133, Rome, Italy
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Hospital Antonio Cardarelli, Contrada Tappino, Campobasso, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy. .,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
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21
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Reconstrução de ruptura crônica do tendão patelar com enxerto patelar contralateral associado a reforço com tendões flexores. Relato de caso. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Reconstruction of chronic patellar tendon rupture using graft from contralateral patella graft together with reinforcement from flexor tendons. Case report. Rev Bras Ortop 2016; 51:378-82. [PMID: 27274495 PMCID: PMC4887442 DOI: 10.1016/j.rboe.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022] Open
Abstract
Chronic patellar tendon rupture is a rare disabling injury that is technically difficult to repair. The true prevalence of this injury is unknown. Delayed reconstruction of chronic patellar tendon rupture has yielded suboptimal clinical and functional results. Many different surgical methods for reconstruction of chronic patellar tendon injury have been reported. In this report, we present a case with chronic patellar tendon injury that was addressed using a technique that had not previously been described in the literature, through combining procedures that had been described separately. The reconstruction method presented in this article has the advantages of being easy and reproducible, without a requirement of allografts.
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23
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Rosso F, Bonasia DE, Cottino U, Dettoni F, Bruzzone M, Rossi R. Patellar tendon: From tendinopathy to rupture. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:99-107. [PMID: 29264248 PMCID: PMC5730651 DOI: 10.1016/j.asmart.2015.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/07/2015] [Accepted: 07/03/2015] [Indexed: 01/08/2023]
Abstract
Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico Hospital, Via Zuretti, Torino, Italy
| | - Umberto Cottino
- Department of Orthopedics and Traumatology, University of Study of Torino, Via Po 8, Torino, Italy
| | - Federico Dettoni
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Matteo Bruzzone
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy.,Department of Orthopaedics and Traumatology, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico Hospital, Via Zuretti, Torino, Italy
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24
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Reconstruction of Chronic Patellar Tendon Rupture Surgical Technique. Tech Orthop 2014. [DOI: 10.1097/bto.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Gomes JLE, de Oliveira Alves JA, Zimmermann JM. Reconstruction of neglected patellar tendon ruptures using the quadriceps graft. Orthopedics 2014; 37:527-9. [PMID: 25102494 DOI: 10.3928/01477447-20140728-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/26/2013] [Indexed: 02/03/2023]
Abstract
Several techniques using different grafts have been described for reconstruction of the patellar tendon after a neglected rupture. Retraction of the quadriceps tendon may compromise repair integrity due to progressive stretching of the graft. The authors present a surgical technique using the central one-third of the quadriceps tendon. This is supported by the fact that the resistance to traction of this segment of the quadriceps tendon equals that of a double-looped semitendinosus graft and that the harvesting of this specific graft promotes muscle inhibition, thus protecting the reconstruction during the recovery period.
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26
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Abstract
Patellar tendon rerupture is a relatively uncommon condition that severely compromises the function of the extensor mechanism of the knee. Few cases described in the literature does not show a unique mode of treatment for this type of lesion. We report the case of a young athlete with traumatic patellar tendon rerupture. The first rupture was treated with the use of Statak anchors. Following a second rerupture incident as a result of a sporting accodent, the tendon was reconstructed with the use of an autologous graft tendon of semitendinosus and biological augmentation with gracilis tendon. For both tendons the distal insertion part was preserved to facilitate the healing process. The treatment was completed with the application of a neutralization cerclage wire and with local injection of plateket reach plasma (PRP). At 12 months follow up, a full recovery of the structure and function of the extensor mechanism was observed and the patient was able to resume normal sports competitive activity.
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27
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Galos DK, Goldstein R, Egol K. Multidisciplinary Reconstructive Approach to Traumatic Extensor Mechanism Disruption: A Case Report. JBJS Case Connect 2014; 4:e3. [PMID: 29252381 DOI: 10.2106/jbjs.cc.m.00102] [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)
- David K Galos
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003. .
| | - Rachel Goldstein
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027.
| | - Kenneth Egol
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003. .
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28
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Sundararajan SR, Srikanth KP, Rajasekaran S. Neglected patellar tendon ruptures: a simple modified reconstruction using hamstrings tendon graft. INTERNATIONAL ORTHOPAEDICS 2013; 37:2159-64. [PMID: 24081511 DOI: 10.1007/s00264-013-2112-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/07/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE We hereby describe a cost effective and simple anatomical reconstruction without requirement for allograft or implants for neglected chronic patellar tendon injuries. This has been validated in seven patients with an average follow up of greater than three years resulting in good outcome. METHODS Seven patients (six males, one female) of mean age 41.8 years (range up to 57 years) presented with neglected patellar tendon injury. The time since injury ranged between three months and three years (average nine months). Active extension was not possible in three patients, and four patients had an extensor lag between 40° and 80° (average 62.5°). Four patients had quadriceps strength of grade 2/5 and three patients had grade 3/5. All patients had severe functional limitation with an average IKDC score of 46.8 (range 39-57). They all underwent patellar tendon reconstruction using hamstrings tendon autograft. RESULTS Postoperatively with a mean follow up of 40.7 months (range 31-52 months), all patients had a stable knee with mean flexion of 125° (range 120°-130°) and without any extension lag. Quadriceps power was regained in five cases to 5/5 and in two cases to 4/5. With an improvement in the IKDC score to 86.8 (range 80-92), excellent outcome was noted in five patients and good outcome in two patients. The average postoperative Lysholm score was 92.4 (range 89-95) and the average Kujala score was 94.5 (range 92-97). CONCLUSION Patellar tendon reconstruction using hamstrings autograft for neglected patellar tendon injuries provides good stability and excellent outcome. Compared to previous techniques described, our technique is unique in being cost effective and a simple anatomical reconstruction without the requirement for allograft or implants.
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Affiliation(s)
- S R Sundararajan
- Department of Orthopaedics, Ganga Hospital, #313, Mettupalayam Road, Coimbatore, 641043, Tamil Nadu, India
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29
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Reconstruction of a ruptured patellar tendon using ipsilateral semitendinosus and gracilis tendons with preserved distal insertions: two case reports. BMC Res Notes 2013; 6:361. [PMID: 24010848 PMCID: PMC3844589 DOI: 10.1186/1756-0500-6-361] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/05/2013] [Indexed: 01/12/2023] Open
Abstract
Background Acute patellar tendon ruptures with poor tissue quality. Ruptures that have been neglected are difficult to repair. Several surgical techniques for the repair of the patellar tendon have been reported, however, these techniques remain difficult because of contractures, adhesions, and atrophy of the quadriceps muscle after surgery. Case presentation We report the cases of 2 Japanese patients (Case 1: a 16-year-old male and Case 2: a 43-year-old male) with patellar tendon ruptures who were treated by reconstruction using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Retaining the original insertion of the STG appears to preserve its viability and provide the revascularization necessary to accelerate healing. Both tendons were placed in front of the patella, in a figure-of-eight fashion, providing stability to the patella. Conclusion Both patients recovered near normal strength and stability of the patellar tendon as well as restoration of function after the operation.
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30
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Maffulli N, Del Buono A, Loppini M, Denaro V. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: average 5.8-year follow-up. J Bone Joint Surg Am 2013; 95:e1231-6. [PMID: 24005207 DOI: 10.2106/jbjs.l.01462] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patellar tendon reconstruction is technically demanding and is indicated in patients with chronic ruptures (i.e., still present more than six weeks after injury). The purpose of this study was to assess the effectiveness of this procedure in patients with impaired function following patellar tendon rupture. METHODS Nineteen patients underwent autologous ipsilateral hamstring tendon graft reconstruction for management of a chronic patellar tendon rupture. The clinical diagnosis was supported by imaging radiographs and magnetic resonance imaging. The modified Cincinnati rating system questionnaire and the Kujala scoring questionnaire were administered preoperatively and at the last examination, an average follow-up of 5.8 years (range, four to 7.8 years) postoperatively. Thigh volume, cross-sectional area of the thigh (muscle and bone), and the maximum isometric voluntary contraction strength of the extensor apparatus of the knee were measured bilaterally in all nineteen patients. RESULTS At the last follow-up visit, knee flexion had increased from a mean of 110° preoperatively to a mean of 132° and extension lag had significantly decreased from 20° preoperatively to 3°; the mean modified Cincinnati and Kujala scores were notably improved. All patients had returned to ordinary daily activities. Fourteen of nineteen patients were very satisfied with the procedure, three were satisfied, one was moderately satisfied, and one was unsatisfied. CONCLUSIONS On the basis of our review of nineteen patients, hamstring tendon reconstruction of chronic patellar tendon rupture provided good functional recovery and return to preinjury daily activities.
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Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
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31
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Tsitskaris K, Subramanian P, Crone D. Neglected patellar tendon rupture. Reconstruction using semitendinosus-gracilis tendon grafts and FiberWire augmentation. JRSM SHORT REPORTS 2013; 4:2042533313490286. [PMID: 24040496 PMCID: PMC3767065 DOI: 10.1177/2042533313490286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
- Pramod B. Voleti
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081;
| | - Mark R. Buckley
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081;
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081;
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33
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Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. Knee 2012; 19:508-12. [PMID: 21835626 DOI: 10.1016/j.knee.2011.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 06/10/2011] [Accepted: 07/17/2011] [Indexed: 02/02/2023]
Abstract
Neglected rupture of the patellar tendon is rare but becomes more difficult to repair the longer it is left untreated. The most common rupture sites are the inferior pole of the patella and distal insertion. Proximal retraction of the patella and extensor mechanism adhesions makes the treatment more difficult than acute tendon rupture. We report two patients with neglected patellar tendon rupture treated by reconstruction and restoration using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Preserved distal insertion provided sufficient blood supply to accelerate healing, while combined fixation with tension-reducing wire, offered the initial stability of the closed-loop sutured tendon. Both patients reacquired near normal strength and stability of the patellar tendon and restoration of function after operation and rehabilitation.
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Affiliation(s)
- Bin Chen
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China.
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34
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Nguene-Nyemb AG, Huten D, Ropars M. Chronic patellar tendon rupture reconstruction with a semitendinosus autograft. Orthop Traumatol Surg Res 2011; 97:447-50. [PMID: 21596640 DOI: 10.1016/j.otsr.2011.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/21/2010] [Accepted: 01/11/2011] [Indexed: 02/02/2023]
Abstract
Chronic patellar tendon ruptures are somewhat rare, thus little work has been done in this area and their true incidence is not known. The management of a neglected, chronic patellar tendon rupture must address three difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair. By presenting a case of a chronic patellar tendon rupture, the advantages of reconstruction with an isolated semitendinosus tendon autograft, especially from an early rehabilitation perspective, are described.
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Affiliation(s)
- A G Nguene-Nyemb
- Department of Orthopaedic Surgery, Pontchaillou Hospital, Rennes Teaching Hospital Center, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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35
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Iacono V, Cigala F, Fazioli F, Rosa D, Maffulli N. Reconstruction of chronic patellar tendon tear with allograft in a patient with Ehlers-Danlos syndrome. Knee Surg Sports Traumatol Arthrosc 2010; 18:1116-8. [PMID: 20033670 DOI: 10.1007/s00167-009-1022-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 11/27/2009] [Indexed: 11/24/2022]
Abstract
Failure of repair of the patellar tendon is uncommon. It may occur in association with chronic systemic diseases or after administration of corticosteroid and quinolones. We report the reconstruction of the patellar tendon with allograft, after failed primary repair, of a 23-year-old young with Ehlers-Danlos syndrome.
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Affiliation(s)
- Venanzio Iacono
- Department of Orthopaedics, Faculty of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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36
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Takai S, Shimazaki N, Yoshino N, Watanabe N, Nakachi N, Kobayashi M, Matsusita T. New technique for knee flexion contracture with patella infera using patellar tendon reconstruction combined with anterior capsular shift: a case report. Arch Orthop Trauma Surg 2009; 129:1383-6. [PMID: 19333608 DOI: 10.1007/s00402-009-0856-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Indexed: 11/28/2022]
Abstract
A 24-year-old male presented with an open fracture of the left patella (Gustilo-Anderson grade III-A) and fracture of the left femoral lateral condyle, and subsequent patella alta suggesting rupture of the left patellar tendon. This initial injury was treated 6 months earlier in another hospital. He was referred because of limited knee motion and radiographs showed severe patella infera. By means of a combination of a contralateral BTB graft and soft tissue repair named anterior capsular shift, the knee contracture with patella infera was resolved successfully.
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Affiliation(s)
- Shinro Takai
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
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Milankov Ziva M, Semnic R, Miljković N, Harhaji V. Reconstruction of patellar tendon rupture after anterior cruciate ligament reconstruction: a case report. Knee 2008; 15:419-22. [PMID: 18650092 DOI: 10.1016/j.knee.2008.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 05/17/2008] [Accepted: 05/19/2008] [Indexed: 02/02/2023]
Abstract
Patellar tendon rupture following use of its central third for anterior cruciate ligament (ACL) reconstruction is a rare disabling injury that is technically difficult to repair. We report one case of patellar tendon rupture after harvesting the mid-third for ACL reconstruction. A number of different surgical methods exist for reconstructing patellar tendon ruptures. Here we report a case using a bone-tendon-bone (BTB) allograft, followed by a multiple-wire loop reinforcement with no postoperative immobilisation. One year after operation, our patient had regained full knee extension and flexion. Insall Salvati index on the operated side was identical to the uninjured side. The patient had good quadriceps strength, and isokinetic muscle testing showed no deficit in his right leg. He was able to return to professional handball without limitation.
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Affiliation(s)
- Miroslav Milankov Ziva
- Department of Orthopaedic Surgery and Traumatology, Clinical Center Vojvodina, Medical School, University of Novi Sad Hajduk Veljkova 1, 21 000 Novi Sad, Serbia.
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38
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Arthroscopic reconstruction of a ruptured patellar tendon: a technical note. Knee Surg Sports Traumatol Arthrosc 2008; 16:581-4. [PMID: 18322673 DOI: 10.1007/s00167-008-0511-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
Abstract
A traumatic patellar tendon rupture of a 35-year-old, otherwise healthy male was reconstructed with semi-tendinosus and gracillis tendons. Tendon grafts were harvested with an open-ended tendon stripper without dissecting them free from their tibial insertion. A transpatellar tunnel was drilled appropriate to the tendon size and a passing pin was used across the length of the patella. Graft bundles were passed in a standard fashion, traversing through the midst of the distal part of the patellar tendon via a beath pin with a loaded looped suture. The endo-button device was then flipped and fixed as an anchor. The patella was positioned at the original placement under arthroscopic visualization and the free ends of the hamstring tendons were attached to a post-fixation screw through the Krackow sutures. Tendon grafts were gathered on the tuberositas tibia and fixed with two additional staples. The patient could flex his knee up to 130 deg at the 3-month follow-up. It was demonstrated that arthroscopic reconstruction of a ruptured patellar tendon may be the optimal surgical choice to minimize trauma and begin early rehabilitation.
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