Neglected patellar tendon ruptures—a simple modified reconstruction using hamstrings tendon graft

Abstract

Purpose We hereby describe a cost effective and simple anatomical reconstruction without requirement for allograft or implants for neglected chronic patellar tendon injuries. This has been validated in seven patients with an average follow up of greater than three years resulting in good outcome. Methods Seven patients (six males, one female) of mean age 41.8 years (range up to 57 years) presented with neglected patellar tendon injury. The time since injury ranged between three months and three years (average nine months). Active extension was not possible in three patients, and four patients had an extensor lag between 40°and 80°(average 62.5°). Four patients had quadriceps strength of grade 2/5 and three patients had grade 3/5. All patients had severe functional limitation with an average IKDC score of 46.8 (range 39-57). They all underwent patellar tendon reconstruction using hamstrings tendon autograft. Results Postoperatively with a mean follow up of 40.7 months (range 31-52 months), all patients had a stable knee with mean flexion of 125°(range 120°-130°) and without any extension lag. Quadriceps power was regained in five cases to 5/5 and in two cases to 4/5. With an improvement in the IKDC score to 86.8 (range 80-92), excellent outcome was noted in five patients and good outcome in two patients. The average postoperative Lysholm score was 92.4 (range 89-95) and the average Kujala score was 94.5 (range 92-97). Conclusion Patellar tendon reconstruction using hamstrings autograft for neglected patellar tendon injuries provides good stability and excellent outcome. Compared to previous techniques described, our technique is unique in being cost effective and a simple anatomical reconstruction without the requirement for allograft or implants.

Técnica de reconstrucción en roturas recidivantes del tendón patelar

“…La reconstrucción del tendón patelar con el uso de autoinjertos ipsilaterales de STG es segura, efectiva y validada desde el punto de vista clínico y funcional. 9, [25][26][27] Además, es un constructo de resistencia probada 34,35 (la configuración en doble banda aporta una resistencia máxima a la carga de 2330N), que asegura una integración adecuada de los injertos. 28 Estos últimos, al ser cosechados rutinariamente en la reconstrucción del ligamento cruzado anterior, permiten realizar una cirugía técnicamente reproducible, pese a la infrecuencia de esta patología.…”

“…Se estima que el diámetro combinado de esos injertos (duplicados) varía en rangos que fluctúan desde los 4 a los 6,5mm. 26 En revisiones, se instalan 2 anclas de titanio en el polo inferior de la rótula y se resutura el tendón lesionado con la técnica de Krackow, 31 para asegurar una adecuada dispersión de las fuerzas a lo largo de la sutura. Las anclas deberían fijarse a aproximadamente 2mm de la superficie articular.…”

Surgical Treatment of Chronic Patellar Tendon Rupture: A Case Series Study

“…Multiple operation techniques with different substances for augmentation have been described for extensor mechanism repair. Autograft and allograft tendons, absorbable and non-absorbable sutures, and wires have been used with good results (8,(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

“…Elsayed Massoud treated twelve fresh patellar tendon ruptures by direct repair and augmentation with absorbable suturing between the patella and tibial tuberosity with good functional outcomes (23). Sundararajan et al reported excellent outcomes of seven cases of chronic patellar tendon rupture reconstructed with semitendinosus and gracilis tendon autografts (24). Milankov and colleagues used a double-wire loop to reinforce a chronic patellar tendon rupture reconstruction with contralateral bone-patellar tendon-bone autograft (27).…”

Arthroscopic Quadriceps Tendon Repair: Two Case Reports

“…Over the years, the repair techniques have progressed from simple suture with catgut or silk to wire-reinforced repair, pull-out suture fixation through patella, suture anchor fixation, tendon lengthening repair, Scuderi technique, allograft, autograft, and synthetic materials [ 1 , 4 , 6 – 12 ]. However, no literature has reported the result using arthroscopy.…”