Traumatic patella tendon rupture: early mobilisation following surgical repair

Bhargava, Sudip; Hynes, M.; Dowell, John K.

doi:10.1016/s0020-1383(03)00069-x

Cited by 63 publications

(58 citation statements)

References 12 publications

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“…Despite the numerous small retrospective series on repair techniques with and without augmentation [1,6,11,13,15,16,23,25,26,28,30,33,36,40], the biomechanical evidence is limited. In 2002, Ravalin et al [35] were the first to describe systematic testing of the efficacy of suture and cable augmentation using a biomechanical model.…”

Section: Discussionmentioning

confidence: 99%

“…The feared complication of catastrophic repair failure historically has led many surgeons to recommended a period of postoperative knee immobilization in extension to decrease the strain across the repair [13,20,22,30,33,37]; however, the benefits of early motion have been shown to include adhesion reduction, improved knee motion, and promotion of tendon healing with earlier remodeling of collagen fibers and increased collagen filaments crosslinking and strength [8-10, 21, 24, 31, 38]. As a result, several augmentation techniques have been described to allow for earlier motion and full weightbearing and perhaps decreasing the risk of failure [1,6,13,15,16,23,25,26,28,30,33,36,40]. Many of the proposed augmentation techniques have required a second operation for removal of the hardware or synthetic material used in the augmentation [6,15,26,36].…”

Section: Introductionmentioning

confidence: 99%

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Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Black

Ricci

Gardner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellar tendon ruptures commonly are repaired using transosseous patellar drill tunnels with modified-Krackow sutures in the patellar tendon. This simple suture technique has been associated with failure rates and poor clinical outcomes in a modest proportion of patients. Failure of this repair technique can result from gap formation during loading or a single catastrophic event. Several augmentation techniques have been described to improve the integrity of the repair, but standardized biomechanical evaluation of repair strength among different techniques is lacking. Questions/purposes The purpose of this study was to describe a novel figure-of-eight suture technique to augment traditional fixation and evaluate its biomechanical performance. We hypothesized that the augmentation technique would (1) reduce gap formation during cyclic loading and (2) increase the maximum load to failure. Methods Ten pairs (two male, eight female) of freshfrozen cadaveric knees free of overt disorders or patellar tendon damage were used (average donor age, 76 years; range, 65-87 years). For each pair, one specimen underwent the standard transosseous tunnel suture repair with a modified-Krackow suture technique and the second underwent the standard repair with our experimental augmentation method. Nine pairs were suitable for testing. Each specimen underwent cyclic loading while continuously measuring gap formation across the repair. At the completion of cyclic loading, load to failure testing was performed. Results A difference in gap formation and mean load to failure was seen in favor of the augmentation technique. At 250 cycles, a 68% increase in gap formation was seen for the control group (control: 5.96 ± 0.86 mm [95% CI, 5.30-6.62 mm]; augmentation: 3.55 ± 0.56 mm [95% CI, 3.12-3.98 mm]; p = 0.02). The mean load to failure was 13% greater in the augmentation group (control: 899.57 ± 96.94 N [95% CI, 825.06-974.09 N]; augmentation: 1030 augmentation: .70 ± 122.41 N [95% CI, 936.61-1124; p = 0.01). Conclusions This biomechanical study showed improved performance of a novel augmentation technique compared with the standard repair, in terms of reduced gap formation during cyclic loading and increased maximum load to failure. Clinical Relevance Decreased gap formation and higher load to failure may improve healing potential and minimize failure risk. This study shows a potential biomechanical advantage of the augmentation technique, providing support for future clinical investigations comparing this

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Black

Ricci

Gardner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…A delay in the diagnosis of patellar tendon rupture also has been reported several times in the literature (6,7,17,22,23). In one review, 10 out of 36 ruptures (28%) were misdiagnosed on initial examination and 7 (19%) were repaired more than 2 weeks after the injury (22).…”

Section: Discussionmentioning

confidence: 94%

“…In one review, 10 out of 36 ruptures (28%) were misdiagnosed on initial examination and 7 (19%) were repaired more than 2 weeks after the injury (22). In another series involving 11 cases of patellar tendon rupture, all of the cases were misdiagnosed in the ED (23). It is important to consider the possibility of a patellar tendon rupture in any patient who presents with knee swelling, inability to stand or walk, inability to actively extend the knee, or has a palpable defect.…”

Section: Discussionmentioning

confidence: 99%

Patellar Tendon Rupture with Underlying Systemic Lupus Erythematosus: A Case Report

Johar

Veenema

et al. 2012

The Journal of Emergency Medicine

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“…Concordamos com Bhargava et al (14) , Enad et al (15) , quando afirmam que o reparo primário protegido com fios de cerclagem, e, a mobilização precoce, propicia excelentes resultados no tratamento, tendo como vantagem diminuir o risco de artrofibrose, conseqüente limitação de movimentos e perda de função articular .…”

Section: Discussionunclassified

Dispositivo de proteção após reparação das rupturas do mecanismo extensor do joelho

Frutos¹,

Camargo²,

Severino³

et al. 2009

Rev. bras. ortop.

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Objetivo: Avaliar os resultados obtidos com a realização da técnica de dispositivo de proteção nos pacientes submetidos à osteossíntese ou sutura de lesões do mecanismo extensor. Méto-dos: Foram avaliados 18 prontuários de pacientes que sofreram lesões traumáticas do aparelho extensor interessando a região entre a tuberosidade anterior da tíbia (TAT) e o ápice da patela submetido à técnica de dispositivo de proteção. A idade variou de 22 a 69 anos, com média de 44 anos. Houve predomínio do sexo masculino em 67 % dos casos. O local mais acometido em 83 % dos casos foi o 1/3 apical da patela. Foi elaborado um protocolo para coleta dos dados informativos relacionando os pacientes e a sua evolução obtida em seus prontuários. Resultados: Observamos a consolidação da fratura de patela em todos os 17 pacientes, e a cicatrização do ligamento patelar num único caso. A dor esteve presente em quatro pacientes, sendo que não observamos nenhuma outra complicação relacionada com a técnica cirúrgica. Conclusão: O dispositivo de proteção é eficiente quando aplicado no tratamento operatório das lesões que se localizam entre o ápice da patela e a TAT propiciando movimentação ativa e passiva no pós-operatório imediato. Descritores

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Traumatic patella tendon rupture: early mobilisation following surgical repair

Cited by 63 publications

References 12 publications

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Patellar Tendon Rupture with Underlying Systemic Lupus Erythematosus: A Case Report

Dispositivo de proteção após reparação das rupturas do mecanismo extensor do joelho

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