Incidence and Risk Factors of Acute Patellar Tendon Rupture, Repair Failure, and Return to Activity in the Active-Duty Military Population

Abstract

Background: Patellar tendon ruptures have a reported incidence of 0.68 per 100,000 person-years in the general population. The epidemiology of surgically treated patellar tendon ruptures in the US military has yet to be reported, which would provide opportunity for identification of risk factors for these otherwise healthy and active patients. Purpose: To determine the incidence of patellar tendon rupture in the Military Health System (MHS) population and to analyze demographic patterns, surgical fixation methods, and rerupture rates. Study Design: Case-control study; Level of evidence, 3. Methods: We utilized the MHS Data Repository (MDR) to identity active-duty military servicemembers surgically treated for patellar tendon rupture between 2010 and 2015. Records were reviewed for demographic information, injury characteristics, fixation technique, and occurrence of rerupture. Risk factors for rupture were calculated using Poisson regression based on population counts and demographic data obtained in the MDR. Risk factors for rerupture and return to duty were analyzed via univariate analysis and multivariate regression. Results: A total of 504 operatively treated primary patellar tendon repairs in 483 patients were identified, with an overall incidence of 6 per 100,000 person-years. Mean age was 33.6 years (range, 17-54 years) and 98% of patients were male. Fixation method was 81% bone tunnels and 7% suture anchors, and 12% were unknown. Black race had a higher relative rate ratio for rupture compared with the race categories White (9.21; P < .0001) and Other (3.27; P < .0001). The rupture rate was higher in 35- to 44-year-old patients compared with those aged 18 to 24 years ( P < .0001), 25 to 34 years ( P < .0001), and 45 to 64 years ( P = .004). Return to full previous level of activity occurred in 75.8% of patients, 14.6% returned to activity with limitations, and 9.5% were medically separated. The rerupture rate was 3%. Fixation method, tobacco usage, body mass index, and race were not significant risk factors for rerupture. Conclusion: The incidence of patellar tendon rupture in the US military population is substantially higher than has been reported in the civilian population. Among military personnel, men, Black servicemembers, and those aged 35 to 44 years were at highest risk for patellar tendon rupture. Three-quarters of patients were able to return to full activity without limitations. The rerupture rate was low and unaffected by fixation method.

Krackow Suture Technique Effect on Patella Tendon Vascularity: Quantitative MRI Analysis

“…1,2 Patellar tendon repairs fail at a rate of 3%, and postoperative infections are more common after patellar tendon repair than quadriceps tendon repair. 3,4 Multiple biomechanical studies have examined the strength of various Krackow suture techniques. 1,[5][6][7][8][9][10][11] This technique, which uses a running locking stitch, has been shown to be superior to other nonlocking suture techniques.…”

“…1,2 Patellar tendon repairs fail at a rate of 3%, and postoperative infections are more common after patellar tendon repair than quadriceps tendon repair. 3,4…”

Patellar Stress Fracture After Suture Anchor Patellar Tendon Repair in an Active Duty Military Member

“…A combination of repetitive microtrauma and natural degeneration of the patellar tendon is believed to predispose younger, active patients to this injury 3 . Patellar tendon rupture has a significantly higher incidence in the US military population than in the civilian population (6 vs. 0.68 per 100,000 person-years) 4,5 . Acute surgical repair is recommended to achieve optimal functional outcomes 1,2 .…”

Reconstructing a Patellar Tendon Rupture Neglected for 14 Years When Anatomic Restoration Is Not Possible

“…Rupture of the patellar tendon is frequently preceded by tendinitis, which likely alters and weakens the fibrous components of the tendon 2 . These injuries most commonly occur because of an eccentric contraction and are frequently found in men near the age of 40 years 3,4 . Complete rupture is usually diagnosed clinically and is associated with a palpable defect below the patella and an inability to actively extend the knee.…”