Semitendinosus autograft augmentation after bilateral patellar tendon re-rupture: a case report and technique note

Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review

The extensor mechanism of the knee can be damaged due to various modes of injury, which, in most cases, will require urgent surgical intervention for repair. Single patellar tendon ruptures are uncommon, but simultaneous bilateral events are even rarer and have been scarcely reviewed in English literature. Research in this area is mainly confined to case series, with some literature reviews but no evidence of more substantial analysis. Therefore, this systematic review was done to analyse the existing literature on bilateral simultaneous patellar tendon ruptures and propose a systematic and standardised approach to diagnosing and managing these injuries. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search terms included 'bilateral patellar tendon rupture', 'bilateral', 'patellar', 'tendon' and 'rupture'. Three independent reviewers conducted searches in PubMed, OvidSP for Medline, Embase and the Cochrane Library using the same search strategy. The eligibility criteria included studies on bilateral concomitant patellar tendon rupture published in English. Bilateral simultaneous patellar tendon ruptures of traumatic and atraumatic origin in human patients were included. The study types comprised case reports and literature reviews. The key limitation of this study was the low number of patients covered by the eligible literature. Patellar tendon ruptures are a rare and scarcely documented injury, and there is a need for studies with a high level of evidence, especially regarding surgical treatment choice and methods, as well as post-operative management, which could potentially lead to improved outcomes in the management of this injury.

A staged procedure for the treatment of chronic patellar tendon ruptures after total knee arthroplasty

The management of extensor mechanism lesions after total knee replacement is still associated with an unacceptably high complication rate, especially in its chronic setting. In this study, we report on 4 patients with chronic (> 3 months) patellar tendon rupture after knee arthroplasty, who were treated with a novel procedure of staged patella advancement prior to reconstruction with autografts. Initially, a unilateral frame was applied connecting the patella with the tibial shaft. The construct allowed for gradual distal advancement of the patella based on the Ilizarov principles. After achieving the desired patella height, the frame was removed, and the patellar tendon was reconstructed with hamstrings. All four patients experienced a significant improvement in extensor lag by a mean of 38.0°, while Knee society scores increased by a mean of 38.5 units. No substantial loss in active knee flexion was observed. Our findings suggest that our technique yields favorable outcomes in patients with patellar tendon disruption in the setting of a total knee arthroplasty.

Patellar Tendon Revision Reconstruction With Hamstring Tendon Autografts

Patellar tendon rupture is an infrequent cause of disability in patients younger than 40 years, with chronic injury and repeat procedures creating difficulty in facilitating healing. Use of hamstring autograft to reinforce the repair has been reported to strengthen the repair construct in patients with previous failure or chronic injury. This technique describes utilization of gracilis and semitendinosus tendon autografts to reconstruct the patellar tendon in a case of primary repair failure.