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

Interest of longitudinal patellar tunnels in reconstructing chronic patellar tendon rupture with semitendinosus autograft: A case report

Treatment of chronic patellar tendon ruptures represents a real challenge for orthopaedic surgeons. The superior patellar migration and the pathological aspect of the tendon are the two conditions that aggravate the situation. Several reconstruction methods have been described in the literature. Hamstring tendon augmentation using horizontal patellar tunnel is widely used in such cases. However, underuse of longitudinal patellar tunnels, although they reproduce the native footprint of the patellar tendon insertion, highlights a missed opportunity in chronic patellar tendon rupture reconstruction. In the current article, we describe a semitendinosus tendon autograft reconstruction technique where the patellar tunnels are drilled longitudinally instead of being drilled transversely from medial to lateral. At 34 months follow-up, our patient claimed full active knee mobility with good quadriceps strength. Reproducing the native footprint of the patellar tendon insertion, through longitudinal patellar tunnels, leads to optimal outcomes after chronic patellar tendon rupture reconstruction with Semitendinosus Autograft.

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.

Treatment of Distal Patellar Tendon Chronic Rupture: The X-Wave Technique

Injuries to the patellar tendon (PT) are associated with knee function deterioration and loss of the capacity to perform daily and sports activities. Patellar tendon injury is often misdiagnosed at emergency rooms, leading to chronic proximal retraction and a challenging clinical scenario. Proximal PT injuries are more common, while distal ones, which can involve tibial bone avulsion fractures or direct tendon avulsion, are rarer. The low incidence of distal PT rupture and the variety of injury patterns make a personal approach reasonable when based on the intraoperative findings and the surgeon's experience. Our purpose is to describe a surgical technique to restore the knee extensor mechanism after chronic distal PT rupture using two kinds of graft, one as a waveform augmentation of the native tendon and the other as reinforcement in a letter X aspect.

Double-Row Suture Anchor Fixation and Achilles Allograft Augmentation for Chronic Patellar Tendon Rupture Repair

Patellar tendon ruptures are functionally devastating injuries that result in failure of the knee extensor mechanism and can lead to a loss of ambulation. Chronic patellar tendon injuries are defined as tears greater than 2 weeks old and are typically more complex to manage than acute tears. Recently, the use of double-row suture anchor configurations has been explored as a technique to provide improved strength in addition to tendon-to-bone compression at the anatomic footprint. The purpose of this article is to describe a surgical technique involving chronic patellar tendon rupture repair using a double-row suture construct augmented with Achilles allograft. Our technique offers a variety of benefits and permits early postoperative mobilization.

"Staged Reconstruction of Chronic Patella Alta with Ilizarov fixator and Achilles Tendon Allograft: A Case report"

Introduction

Chronic patella alta after chronic patellar tendon rupture or patella fracture non-union is a challenging condition to treat.

Case Report

In this report, we present the case of a 50-year-old male with inferior patellar pole fracture with non-union and chronic patella alta from a chain saw accident 12 years before presentation. An Ilizarov frame was used to reduce the patella to anatomic position before reconstructive surgery for knee extensor mechanism repair using an Achilles tendon allograft.

Conclusion

This case demonstrated the efficacy of the Ilizarov frame in the setting of chronic patella alta where primary repair would have been impossible due to significant scar tissue formation and quadriceps contracture.

Achilles Tendon Allograft with Semitendinosus Autograft Reinforcement Is a Successful Treatment for Chronic Patellar Tendon Rupture: Report of Two Cases

Rupture of the patellar tendon must be diagnosed urgently because reconstruction of the extensor mechanism produces better results when it is performed in acute conditions. Reconstruction of chronic extensor mechanism rupture on the contrary is very challenging. Several surgical techniques have been described using a variety of graft choices and fixation methods, but the optimal approach is still under debate. We report our experience of two cases of chronic patellar tendon rupture reconstruction using an Achilles tendon allograft reinforced by a vascularized ipsilateral semitendinosus tendon frame. The rapid functional recovery of the range of motion, only three months postoperatively, showed us that this reconstruction technique was effective.

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.