Surgical Technique to Bring Down the Patellar Height and to Reconstruct the Tendon for Chronic Patellar Tendon Rupture

Abstract

Although surgical treatment is the gold standard for chronic patellar tendon rupture, the technique of patellar tendon reconstruction is still difficult. Basically, good clinical results of surgical repair for acute patellar tendon rupture have been reported. However, the results of reconstructive surgery for chronic patellar tendon rupture are still inconsistent. Some surgical options have been previously reported. For example, surgeons need to choose between 1- and 2-stage reconstruction. Furthermore, contralateral bone-tendon-bone graft, ipsilateral semitendinosus tendon graft, Achilles tendon allograft, and an artificial ligament have been used to reconstruct the patellar tendon. Generally, surgeons are concerned about postoperative complications, including loss of knee flexion, quadriceps weakness, and wound problems. One of the key points to avoid these complications is to improve proximal patellar migration. The purpose of this article is to present an easy and safe technique to bring down the patellar height with polyethylene tape and to reconstruct the patellar tendon with an artificial ligament. Although it has limitations, the described technique can facilitate reconstruction of chronic patellar tendon rupture.

Patellar Tendon Reconstruction for a Chronic Extensor Mechanism Deficit Using an Achilles Tendon Allograft With Hamstring Autograft and Suture Augmentation

“…Previously described reconstruction techniques include use of autografts, allografts, xenografts, and synthetic material, as well as combinations of thereof. [8][9][10] McNally and Marcelli 11 as well as Falconiero and Pallis 12 described reconstruction techniques using an Achilles allograft augmented with a suprapatellar tension-band wire with a subsequent operation to remove the wire. George and Jorgensen 13 described a reconstruction technique using an Achilles tendon allograft bone plug that was shaped to press fit into a tunnel in the tibial tubercle and secured with a biocomposite interference screw.…”

“…When direct repair of the tendon is not possible, the tendon is augmented using either allografts or autografts. 1,[4][5][6][7][8][9] In the absence of any viable patellar tendon tissue, a reconstruction is necessitated. Because chronic patellar tendon injuries are rare, there is no consensus on the optimal approach for treatment.…”

Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages

“…Harato et al 29 described a surgical technique in which they use cannulated screws and polyethylene tape, using a device that, when rotating on itself, shortens the polyethylene tape and thus achieves distalization of the patella; at the same time, they reconstruct the patellar tendon with a Leeds-Keio artificial ligament. According to the authors, the technique should be used in cases in which the patella does not show a great amount of retraction.…”

Knee Extensor Mechanism Disruptions: A Review

“…Results are inconsistent with chronic PT ruptures or re-ruptures [55] . Challenges include tendon quality, retraction and lack of patellar mobility.…”

“…Challenges include tendon quality, retraction and lack of patellar mobility. Prolonged post-operative immobilization is often necessary, leading to quadriceps contracture, weakness and loss of knee flexion [55,56] . The patella is pulled proximally secondary to quadriceps contracture and distal patellar mobilization is a primary surgical goal [55] .…”