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

[Reconstruction of the patellar tendon with autologous or allogeneic semitendinosus tendon transplant for chronic rupture]

OBJECTIVE

Reconstruction of a patellar tendon defect in the event of a chronic rupture.

INDICATIONS

Chronic rupture of the patellar tendon due to delayed diagnosis or failure of primary refixation with a dehiscence that does not allow for anatomical refixation without patellar tendon shortening.

CONTRAINDICATIONS

Infection.

SURGICAL TECHNIQUE

Approximately 15 cm long incision from the tibial tuberosity to the patella. Depicting the rupture. Debridement of the tendon and insertion. Suture in the quadriceps tendon and distalization of the patella. If sufficient distalization of the patella is not possible, optionally perform a VY-plasty of the quadriceps tendon. Measuring the dehiscence. Securing the height of the patella by applying a patellotibial cerclage (strong suture cord). Extension of an existing tendon stump using a Z-plasty. Creation of 2 bone tunnels (diameter approx. 5 mm) in the patella and the tibial tuberosity. Insertion of an autologous or allogeneic semitendinosus tendon transplant and securing it by knotting the retaining threads in front of the tibial tuberosity.

POSTOPERATIVE MANAGEMENT

Six weeks of partial weight-bearing with 10 kg of body weight in a straight, removable splint. Range of movement: weeks 1-4 E/F 0-0-60°, weeks 5-6 E/F 0-0-90°.

RESULTS

Seven patients who underwent this surgery as described above had a minimum follow-up of 2 years. Secondary lengthening of the quadriceps tendon had to be performed twice due to excessive retraction. All patients were able to perform active extension postoperatively. The Lysholm score rose from 49.3 to 83.2 points. No further rupture was detectable in the final ultrasound examination.

Reconstruction of Chronic Quadriceps and Achilles Tendon Ruptures Using Achilles Allografts: Clinical Findings and Review of Literature

Background/Objectives: Chronic ruptures of the quadriceps and Achilles tendons present significant reconstructive challenges due to factors such as tendon retraction, scar tissue formation, and compromised tissue quality. Traditional repair methods, including V-Y tendinoplasty, autografts, and synthetic scaffolds, often prove inadequate for large or neglected defects. Achilles tendon bone-tendon allografts have emerged as a promising alternative, offering strong fixation, biological incorporation, and sufficient length for bridging extensive gaps. This study aims to document the clinical, radiographic, and MRI outcomes of two challenging cases treated with Achilles tendon bone-tendon allografts and to synthesize these findings within the context of the existing literature to evaluate the broader viability of this reconstructive approach. Methods: An observational analysis was conducted at the Orthopedic and Traumatology Clinic of "Victor Popescu" Military Emergency Hospital in Timișoara, encompassing two patients with chronic, iterative tendon ruptures-one quadriceps tendon rupture and one Achilles tendon rupture. Both patients had previously failed primary repairs, resulting in significant tendon retraction and tissue deficits. Reconstruction was performed using Achilles tendon bone-tendon allografts, involving specific osteotomy techniques for patellar and calcaneal fixation. Postoperative protocols included immobilization followed by structured physiotherapy. Clinical assessments and MRI evaluations were conducted at 8, 12, and 24 weeks postoperatively. Additionally, a comprehensive literature review was performed to compare our findings with existing studies on Achilles bone-tendon allograft utilization in chronic tendon reconstructions. Results: Both patients exhibited substantial improvements in their range of motion and reported low pain levels at the 8- and 12-week follow-ups. MRI assessments indicated well-aligned graft fibers, early bone block integration, and the absence of complications such as re-rupture or infection in the long term. Functional recovery was achieved with complete bone block union and return to normal activities by 24 weeks. The literature review corroborated these outcomes, demonstrating that Achilles tendon bone-tendon allografts provide robust fixation and facilitate biological integration, particularly in cases with large defects and poor tissue quality. Comparative studies highlighted similar functional improvements and graft stability, reinforcing the efficacy of bone-tendon allograft constructs over traditional repair methods in chronic tendon ruptures. Conclusions: Achilles tendon bone-tendon allografts are effective in reconstructing chronic quadriceps and Achilles tendon ruptures, offering robust fixation and facilitating biological integration. These findings, supported by the existing literature, suggest that Achilles bone-tendon allografts are a viable alternative to traditional repair strategies, especially in patients with extensive tendon defects and compromised tissue quality. Further comparative studies are warranted to establish the superiority of bone-tendon allograft constructs over conventional methods.

Neglected Patellar Tendon Rupture Treated With a Single Semitendinosus Tendon in One-Stage Reconstruction Surgery: A Case Report of an Unusual Injury Mechanism

We present the case of a 23-year-old patient who sustained a gunshot wound (GSW) during a mass shooting and had an unrecognized rupture of the patellar tendon. The patient was treated with a single-stage reconstruction, using only the semitendinosus tendon with preserved distal tendon insertion and two tunnels, transtibial and trans patellar, along with McLaughlin augmentation of the repair. The reconstruction proved strong enough to withstand the postoperative rehabilitation process. At the one-year follow-up, the patient walked without pain, had a full range of motion, and had enough muscle strength in the upper leg. The MRI showed the injured leg had almost the same Insall-Salvati ratio and Caton-Deschamps index as the uninjured leg.

Advancements in biomaterials and scaffold design for tendon repair and regeneration

Tendon injuries present a significant clinical challenge due to their limited natural healing capacity and the mechanical demands placed on these tissues. This review provides a comprehensive evaluation of the current strategies and advancements in tendon repair and regeneration, focusing on biomaterial innovations and scaffold design. Through a systematic literature search of databases such as PubMed, Scopus, and Web of Science, key studies were analyzed to assess the efficacy of biocompatible materials like hydrogels, synthetic polymers, and fiber-reinforced scaffolds in promoting tendon healing. Emphasis is placed on the role of collagen fiber architecture, including fiber diameter, alignment, and crimping, in restoring the mechanical strength and functional properties of tendons. Additionally, the review highlights emerging techniques such as electrospinning, melt electrowriting, and hybrid textile methods that allow for precise scaffold designs mimicking native tendon structures. Cutting-edge approaches in regenerative medicine, including stem cell therapies, bioelectronic devices, and bioactive molecules, are also explored for their potential to enhance tendon repair. The findings underscore the transformative impact of these technologies on improving tendon biomechanics and functional recovery. Future research directions are outlined, aiming to overcome the current limitations in scaffold mechanical properties and integration at tendon-bone and tendon-muscle junctions. This review contributes to the development of more effective strategies for tendon regeneration, advancing both clinical outcomes and the field of orthopedic tissue engineering.

Evaluating the Impact of Biological Augmentation on Failure Rates and Complications in Acute Patellar Tendon Rupture Surgery Compared With Isolated Repair

Background

Patellar tendon ruptures are infrequent but disabling injuries. Surgical treatment is the gold standard to obtain good outcomes, and numerous techniques have been described. Biomechanical studies report better results when augmented techniques are used. However, there is a lack of consensus regarding the best standard technique.

Purpose/Hypothesis

The purpose of this study was to assess a cohort of patients with acute patellar tendon rupture that was surgically treated and to compare the clinical outcomes of 2 groups: isolated repair and biological augmentation techniques with autograft or allograft. It was hypothesized that the biological augmentation group would have better clinical outcomes than the isolated repair group.

Study Design

Cohort study; Level of evidence, 3.

Methods

All patients with acute patellar tendon rupture surgically treated in our center between 2016 and 2022 were retrospectively reviewed. Patient and rupture characteristics, surgical technique, clinical outcomes, and complications were recorded. The primary outcome was rerupture rate, and secondary outcomes were infection rate, stiffness >15° of knee flexion deficit, and extensor mechanism lag >5°.

Results

The study included 34 patients with 36 operated knees (2 patients with bilateral rupture). The mean age was 44.9 years. Isolated repair was performed in 20 knees (55.6%), and 16 knees underwent repair and biological augmentation with autograft or allograft. Both groups were comparable in terms of their demographic characteristics. A statistically significant association was found between the type of surgery and tendon rerupture. Of the patients in the isolated repair group, 5 of 20 (25%) experienced a failure, whereas in the biological augmentation group, no reruptures were recorded (P = .031). However, no statistically significant associations were found between the type of surgery and other complications, such as the development of stiffness (P = .54), residual extension lag >5° (P = .87), or the development of infection (P = .25).

Conclusion

In this cohort of patients, biological augmentation reduced the rate of surgical failure for acute patellar tendon rupture without being associated with a higher risk of complications such as stiffness, residual extension lag, or the development of infection.

Treatment outcome of chronic patellar tendon rupture using autogenous semitendinosus graft: a retrospective case series

PURPOSE

This study highlights the pattern of presentation, treatment, early functional outcome, and complications observed in the management of chronic patellar tendon ruptures using our preferred technique of autogenous semitendinosus graft reconstruction.

METHODS

This was a retrospective case series involving consecutive patients who underwent patellar tendon reconstruction and met the inclusion criteria. The outcome measures were determined by the post-operative knee range of motion (R.O.M), the post-operative International Knee Documentation Committee (IKDC) score, and pattern of post-operative complications.

RESULTS

Nine patients were included in this case series. The mean age of the patients was 35.4 ± 6.8 years (range 27-44 years). Trauma to the knee accounted for majority of the cases (62.5%). Six (66.7%) of the nine patients suffered a patellar tendon rupture from contact injury during sporting activities. The mean length of time from injury to presentation was 20.5 ± 11.2 weeks (range 6-69.5 weeks). Normal knee function in a case (11.1%), nearly normal knee function in 7 cases (77.8%), and abnormal knee function in a case (11.1%) were recorded as a measure of outcome of surgery. The mean post-operative IKDC score was 70.0 ± 6.1 (range 55-77), which was higher than the mean pre-operative score of 26.4 ± 5.1 (range 18-32). The post-operative knee R.O.M averaged 97.2 ± 16.2° (range 70-120°) with a single case with a 10° extension lag noted.

CONCLUSION

Normal to near-normal knee function was obtained with the treatment of chronic patellar tendon rupture in the majority of cases using autogenous semitendinosus graft for patellar tendon reconstruction in our series.

Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report

BACKGROUND

Gout is a disease characterized by hyperuricemia, and resultant deposition of uric acid crystals in tissues. While typically manifested as intraarticular crystals or tophi, gout can also cause pathology at entheses. Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture. Furthermore, allografts can also be at risk of rupture in the setting of severe gout. We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.

CASE SUMMARY

A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs. She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years. This patient presented with pain and extensor lag. A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle. The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction. She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks. At twelve weeks, she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.

CONCLUSION

Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.

Reconstruction of a Neglected Patellar Tendon Rupture in an Adolescent: A Case Report

We present a case of a neglected patellar tendon rupture, misdiagnosed as an anterior cruciate ligament tear, in a 12-year-old child with open physis without an avulsion fracture. The patient was treated with an ipsilateral hamstring tendon autograft with preserved distal insertions, a transpatellar tunnel, and a transtibial fixation. At the final follow-up, the patient had a full range of motion and a fully functional knee. The described technique results in complete muscle strength, full range of motion, and pain-free gait. It can be used in chronic patellar tendon ruptures and is a valuable addition to the therapeutic quiver for this type of injury.

Surgical treatment of patellar tendon rupture after total knee arthroplasty with a double-row repair method using the hamstring tendons: A novel technique with functional results

BACKGROUND

Patellar tendon rupture (PTR) is extremely rare but serious complication after primary or revision total knee arthroplasty. Due to the serious failure rates of end-to-end repair techniques, various augmentation techniques have been described. In this study, the results of patients with PTR after reconstruction using our own technique with semitendinosus (ST) and gracilis tendons taken from the affected side were evaluated retrospectively.

METHODS

A total of 14 patients, whose diagnosis was made based on physical examination and clinical findings, and supported radiologically (ultrasonography), were included in the study. In these patients, reconstruction was performed using double-row repair technique with the ST and gracilis tendons. Active-passive knee joint range of motion, active knee extension loss, and the Caton-Deschamps index at preoperative and final follow-up visits were compared. Tegner-Lysholm knee score and Kujala score were used to evaluate functional results.

RESULTS

In 14 patients (8 women and 6 men) with a mean age of 68.1 years, the median time between injury and surgery was 6.6 weeks. In all patients, the rupture was in the distal part of the patellar tendon. While the median preoperative Caton-Deschamps index was 1.8, the postoperative median value was found to be 1.25 after an average follow-up of 3.8 years (P = .014). The median preoperative knee extension loss decreased from 25° to 5° postoperatively. Tegner-Lysholm knee score and Kujala score of the patients at their last follow-up were significantly increased (P < .01).

CONCLUSION

For PTR developing after total knee arthroplasty, the double-row reconstruction technique with ST and gracilis tendons is effective.

Patellar Tendon Rupture 12 Years after ACL Reconstruction with BPTB Autograft

We present a case of a 33-year-old male with a history of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft and prior ipsilateral hamstring harvest, who presented with a complete patella tendon rupture (PTR) 12 years after ACLR. The patient underwent a successful patellar tendon (PT) repair augmented with Achilles tendon allograft and cerclage with nonabsorbable suture tape. PTR after ACLR with BPTB autograft is rare, particularly in patients over a decade out from the index procedure, but can occur. This case report highlights a novel technique for PT repair following BTB ACLR in a hamstring deficient knee.

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.