Clinical and Biomechanical Outcomes of One-Stage Treatment of a Simultaneous Ipsilateral Patellar Tendon and ACL Tear Combined with a Tibial Plateau Fracture: A Case Study

Abstract

Simultaneous ipsilateral patellar tendon (PT) and anterior cruciate ligament (ACL) tear is a rare injury. Associated meniscal and ligamentous injuries are common but frequently initially missed. In contrast, to date, there is no report of associated fractures. We report on a 40-year-old female Caucasian patient presenting with a ski injury resulting in simultaneous ipsilateral patellar tendon and ACL tear combined with a tibia plateau fracture and a medial and lateral meniscus lesion. ORIF of the tibia as well as one-stage primary reconstruction of the PT and ACL and suturing of the menisci was conducted. The final follow-up was 2 years postoperatively. Lower extremity kinematic, kinetic, and muscle activity measurements were conducted. Although the clinical result was excellent, altered joint kinematics went along with large side-to-side difference in hip and knee joint moments during midstance and terminal stance. During weight acceptance, vastus medialis and hamstring muscles showed greater relative activity in the injured than the uninjured side. This case demonstrates the possibility of excellent early and midterm results with a one-stage approach and suitable rehabilitation scheme. Biomechanical measurements could further help evaluate the outcome of the treatments and implications for the development of potential secondary damage.