Neglected patellar tendon rupture. Reconstruction using semitendinosus-gracilis tendon grafts and FiberWire augmentation

Technique for Fixation of Semitendinosus to the Patella in Patellar Tendon Reconstruction

“…Some use a Steinmann pin or cerclage wires through a transverse tunnel, 2 , 19 and others use FiberWire passed transversely. 4 We believe this is an additional tunnel that is increases the risk of the patellar fracture. We relied on a pointed reduction towel applied on the medial and lateral borders of the patella for manipulation.…”

“…However, in the polydioxanone suture group there was a greater rate of postoperative infection. Tsitskaris et al 4 in their series used FiberWire to supplement the reconstruction. It allows a robust secure construct, yet does not require removal of metalwork and does not limit the degree of flexion as opposed to the use of cerclage wire described in other series.…”

“…2,9 The most difficult and challenging step faced is mobilizing the upward retracted high riding patella. 4 Tsitskaris et al 4 advocate quadriceps tendon V-Y plasty and suggest that it must always be discussed with the patient and be added to the consent form. They, however, reported that it was not required in any of the patients in their series.…”

“…However, the timing of surgery is very crucial, as we know from the literature that formation of adhesions, muscle contractures, and retraction of the extensor mechanism with proximal migration of the patella increase over time from the time of injury and all add up to the complexity of these injuries and the difficulty faced by both the surgeon intraoperatively on one hand and the patient and the rehabilitation team postoperatively on the other. [2][3][4][5] Postoperative complications include but are not limited to intraoperative fractures, limited range of motion (ROM), including flexion and/or extension, weak quadriceps and anterior giving way, wound dehiscence, and breakdown. Other less-serious problems include significant anterior knee pain, implant irritation, and donor-site morbidity.…”

“…However, the timing of surgery is very crucial, as we know from the literature that formation of adhesions, muscle contractures, and retraction of the extensor mechanism with proximal migration of the patella increase over time from the time of injury and all add up to the complexity of these injuries and the difficulty faced by both the surgeon intraoperatively on one hand and the patient and the rehabilitation team postoperatively on the other. 2 , 3 , 4 , 5…”