Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: Two case reports

Chen, Bin; Li, Runguang; Zhang, Sheng

doi:10.1016/j.knee.2011.07.007

Cited by 45 publications

(39 citation statements)

References 30 publications

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“…In 2007, Van der Zwaal [10] reported two cases using semitendinosus and gracilis for reconstruction with augmentation of fixation by bioscrews and staples. In 2012, Chen et al [11] reported two cases using semitendinosus and gracilis for reconstruction retaining the distal insertions of the tendons proposing preservation of vascularity of the tendons. Similar cases have been reported as single case reports using various techniques with different graft choices that included autograft (contralateral patellar tendon [12], semitendinosus tendon [3,5,13]), allograft (massive extensor mechanism graft [14], Achilles tendon [15][16][17]) or synthetic materials (carbon fibre [18], Dacron [19], LARS [20]).…”

Section: Discussionmentioning

confidence: 99%

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

Sundararajan

Rajasekaran

2013

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 99%

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

Sundararajan

Rajasekaran

2013

International Orthopaedics (SICOT)

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“…Ecker et al, 8 McNally and Marcelli, 23 and Falconiero and Pallis 10 used a single wire in a simple loop fashion to augment their repairs. Chen et al 5 modified the technique by Ecker et al, 8 using an autogenous hamstring graft and a circular wire through the patellar and tibial tunnels instead of a Steinman pin for patellar traction. Milankov et al 24 used an autogenous contralateral BPTB graft reinforced by a double-wire loop.…”

Section: Discussionmentioning

confidence: 99%

Neglected Patellar Tendon Rupture With Massive Proximal Patellar Migration Treated With Patellar Transport and Staged Allograft Reconstruction

Elattar

Coleman

Warren

et al. 2016

Orthopaedic Journal of Sports Medicine

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Neglected or chronic ruptures of the patellar tendon are defined as ruptures presenting after 6 weeks. Late presentation is often due to neglect or missed diagnosis. 1,12 With chronic ruptures, the patient presents with weakness, instability, and pain. Management of patients with chronic ruptures is difficult due to adhesions, proximal patellar migration, contracture, and quadriceps muscle atrophy. 29 Before reconstruction of the patellar tendon (using autografts, allografts, or synthetic materials), the position of the patella must be normalized. Several methods had been reported to relocate the proximally migrated patella distally to its anatomic location, including preoperative traction, intraoperative traction, quadricepsplasty, and external fixation. 8,15,17,20,27,30,31,33 The aim of this case report was to present the use of ring and wire external fixation applying the lengthening principles of Ilizarov 13 to mobilize the proximally migrated patella distally as a successful treatment of chronic neglected patellar tendon rupture followed by second-stage patellar tendon reconstruction using an allograft. We report our experience in 2 cases, with an improved modification of the external fixator construct used for distal patellar transport in case 2. This report of 2 cases was approved by the Hospital for Special Surgery Institution Review Board. CASE 1A 44-year-old man presented to the office of the senior authors (S.H.C., S.R.R.) with bilateral posttraumatic chronic patellar tendon ruptures and proximal migration of the patellae. The patient was involved in a severe jet-ski accident in which he sustained this bilateral injury and ruptured his spleen and was on a ventilator due to a brain injury for almost 1 year. Because of the severity of his other injuries, the patellar tendon ruptures were not initially diagnosed. After being weaned from the ventilator, it was noted that he had bilateral extensor lag, with both patellae migrated proximally into the midthigh region. He was in a rehabilitation facility since he came off the ventilator. The patient presented in a wheelchair with a chief complaint of inability to walk accompanied by bilateral anterior knee pain. The patient presented to the sports medicine service 3 years after the injury.The patient, who was not able to stand, had full painless range of motion (ROM) of both hips. The knee ROM on both sides was from 15 to 110 of flexion, and there were severe extensor lags of both knees of 25 . Both patellae were migrated proximally at the junction of the proximal

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“…Preservation of the original distal insertion of the ST appears to preserve its viability and provide sufficient blood supply to accelerate healing and avoid avascular necrosis and revascularization that occurs with the use of a free tendon autograft [17].…”

Section: Discussionmentioning

confidence: 99%

“…Chen et al [17] reported the reconstruction of a ruptured patellar tendon using STG tendons with preserved distal insertions. However, in their technique, a combined fixation with wire was required.…”

Section: Discussionmentioning

confidence: 99%

Patellar tendon rupture after total knee arthroplasty: semitendinosus tendon graft augmentation with direct repair

Abdelazim

Diab

2015

Eur Orthop Traumatol

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Introduction Rupture of the patellar tendon after total knee arthroplasty is an infrequent but serious complication. Several methods for treating this catastrophic complication have been described. The purpose of this article was to evaluate the results of semitendinosus graft augmentation with direct repair in the treatment of patellar tendon rupture after total knee arthroplasty. Material and methods From 2012 to 2014, six patients who underwent cemented total knee arthroplasty without patellar resurfacing presented with patellar tendon rupture after operation. Patellar tendon repair and augmentation with autogenous ipsilateral semitendinosus graft was scheduled with preparation of stocks of primary and revision prosthesis. Results All knees required revision either all components or one of the components. Postoperative radiograph confirmed that normal patellar height was with good alignment of all prosthesis components. Patients were followed up for average 1.5 years. No intra-or postoperative complications were recorded. Functionally, scores at final follow-up were excellent in two patients and good in four patients according to Knee Society clinical rating scores. The average active range of motion is from 10 to 135°. All patients could return to their daily activities without pain. Conclusion The right alignment and rotation of the knee prosthesis, together with good surgical technique in a primary operation, are the most important factors to avoid the catastrophic complication of patellar tendon rupture during or after the total knee arthroplasty. However, if patellar tendon rupture does occur, the use of our operative technique and rehabilitation program can bring good functional results.

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Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: Two case reports

Cited by 45 publications

References 30 publications

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

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

Neglected Patellar Tendon Rupture With Massive Proximal Patellar Migration Treated With Patellar Transport and Staged Allograft Reconstruction

Patellar tendon rupture after total knee arthroplasty: semitendinosus tendon graft augmentation with direct repair

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