Acute, simultaneous tear of patellar tendon and ACL: possible mechanism of injury and rationality of the two-stage surgical treatment

Abstract

BACKGROUNDPatellar tendon and anterior cruciate ligament (ACL) tear is an uncommon injury. Moreover, the mechanism of injury and the best surgical approach have not been established yet. We believe that case reports like ours contribute to a better understanding of the mechanism of injury and help the surgeon to decide whether to proceed in one-or twostage procedure. CASE PRESENTATIONA 47-year-old professional driver presented in the outpatient clinic of our department after sustaining an injury in his left knee. He was manually unloading a heavy package from his truck and while descending to the ground he felt a double 'pop' in his left knee and fell down. Physical examination revealed diffuse knee swelling. The knee was extremely tender, even in slight palpation, especially anteriorly and medially. A palpable defect of the patella tendon was detected, and active knee extension was impossible. Valgus stress demonstrated medial collateral ligament (MCL) disruption while Lachman-Noulis and pivot-shift test could not be performed because of the intense pain. The anteroposterior and lateral radiographs showed superior displacement of the patella without any other osseous pathology. Consequently, the patient was admitted in our department, under the diagnosis of patellar tendon and MCL tear.

Simultaneous Rupture of Patella Tendon with Tibial Tubercle Avulsion Fracture, Anterior Cruciate Ligament Avulsion Fracture of the Tibial Spine in a Skeletally Mature Patient: A Case Report

“…1 Ten case reports, including 17 patients, of ipsilateral simultaneous rupture of the patella tendon and ACL have been reported. [6][7][8][9][10][11][12][13][14][15][16] There was one case report of a tibial tubercle avulsion fracture and a tibial spine avulsion fracture with no rupture of the patella tendon. 17 This report outlines the unique situation when both of these fractures occur together with a patella tendon rupture and we provide a logical treatment option for this complex injury pattern.…”

Simultaneous Rupture of the Anterior Cruciate Ligament, Medial Collateral Ligament and Patellar Tendon: A Case Series, Review of the Literature, and Proposed Treatment Algorithm

“…Conversely, the standard ACL rehabilitation protocol emphasizes the gradual restoration of knee range of motion, closed chain exercises, and weight bearing as tolerated in the immediate post-operative phase of rehabilitation [25]. If the rehabilitation period for ACL reconstruction is delayed, the risk of loss of function and development of arthrofibrosis increases [8,25]. By delaying reconstruction of the ACL, the patient is able to appropriately rehabilitate the PT repair, assure adequate range of motion, control swelling and reduce the overall risk for arthrofibrosis when compared to a single stage repair combined procedures may increase the risk of rehabilitation-related complications as arthrofibrosis, which may require repeated closed manipulation or arthroscopic lysis of adhesions [3].…”

“…They did not discuss the reason for not reconstructing the ACL. Additionally, Koukoulias, et al [8] described a 47-year-old male who sustained a rupture of his PT, ACL, and MCL. The diagnosis of ACL rupture was missed during initial evaluation and was discovered at the time of surgery.…”

Surgical Management of Simultaneous Anterior Cruciate Ligament and Patellar Tendon Ruptures: A Systematic Review

“…1). [19][20][21][22][23][24][25][26][27][28][29] One of the 11 studies had 6 individual cases reported with 2 of the cases having a PT repair without ACL reconstruction; these 2 cases were excluded from the final analysis. 26 The final analysis had 18 cases.…”