Acute patellar tendon rupture

Summary: The most common method used in the treatment of acute patellar tendon ruptures is primary end-to-end repair. The use of the Acufex ACL guide (Acufex Microsurgical, Mansfield, MA) provides efficient and accurate placement of transosseous drill holes in the patella and minimizes the risk, tourniquet time, and surgical time of acute patellar tendon repairs.     

Chronic patellar tendon rupture: surgical reconstruction technique using 2 Achilles tendon allografts

Delayed reconstruction of chronic patellar tendon ruptures classically has yielded suboptimal results. Quadriceps contracture, distal patella mobilization, quadriceps lengthening (eg, V-Y lengthening), prolonged postoperative immobilization, residual quadriceps weakness, surgical macro failure, and loss of knee flexion are some of the complications associated with treatment for chronic patellar tendon rupture. Reinforcement hardware (eg, cerclage wire) may necessitate subsequent removal and the possibility of breaking with migration through the body. This article details the use and short-term success of a surgical technique using 2 Achilles tendon allografts for reconstruction of a chronic patellar tendon rupture.     

One-stage reconstruction of skin defect and patellar tendon rupture after total knee arthroplasty: A new technique

A case is presented herein in which infected total knee arthroplasty associated with a skin defect and patellar tendon rupture was reconstructed with lateral gastrocnemius-Achilles tendon complex after infection was controlled. The results were satisfactory, and the technique proposed herein is highly promising for treating such complicated circumstances after total knee arthroplasty, as not reported previously.     

Chronic rupture of a patellar tendon: A technique for reconstruction with achilles allograft

Chronic ruptures of the patellar tendon fortunately are an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by quadriceps muscle contracture and a great deal of scar tissue formation. We report the case of a repair of a chronic patellar tendon rupture. The patient's right patellar tendon was reconstructed approximately 10 months after the injury using quadricepsplasty and an Achilles tendon allograft with a suprapatellar wire for tension release. Four weeks postoperatively, he had attained 60° of flexion and full active extension. At 8 weeks, the suprapatellar wire was removed allowing the distribution of stresses on the reconstructed patellar tendon. At 6 months, the patient had 130° of flexion and full extension, but showed a persistent 40% deficit in right quad strength. The technique accomplished the preoperative goals of restoring quadriceps function, restoring the anatomic position of the patella, and allowing early mobilization after surgery. Although the use of a suprapatellar wire to reduce tension on the reconstructed tendon required a second operation for removal, it allowed early mobilization and better healing of the repair.     

Quadriceps and patellar tendon rupture

Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.     

Neglected rupture of the patellar tendon

Neglected rupture of the patellar tendon is a rare but well recognised complication of knee trauma. We present the case of a 43-year-old man who sustained a complete rupture of the patellar tendon of his left knee following a fall. Clinical diagnosis was delayed by 2 months and was confirmed by magnetic resonance imaging. Treatment began with skeletal patellar traction and was followed by late reconstruction of the patellar tendon and transfer of the gracilis and semitendonosus tendons supplemented by figure-of-eight tension band wiring. Received: 6 November 1997     

Neglected bilateral rupture of the patellar tendon: A case report

Simultaneous bilateral rupture of the patellar tendon (PT) is extremely rare and is generally associated to some chronic diseases. When the rupture becomes chronic, it is more difficult to repair that as it remained untreated.The diagnosis, which is clinical, is often delayed, guided by standard radiography and confirmed by ultrasound or MRI.The management of a bilateral neglected, chronic patellar tendon rupture must address some serious difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair.We report a case of neglected bilateral rupture of the patellar tendon in a chronic hemodialysis patient, treated with a plastic surgery of the ipsilateral quadriceps tendon.     

Neglected patellar tendon rupture: preserve the fat pad

Management of neglected patellar tendon ruptures remains a difficult therapeutic endeavor, as complications such as adhesions, proximal patellar migration, and quadriceps contracture occur. Treatment goals include restoration of extensor mechanism, both structurally and functionally, which allows active knee extension. Few cases of neglected patellar tendon rupture have been reported in the literature, however, all have used preoperative or additional intraoperative procedures to relocate the patella or to provide additional support to the reconstructed tendon. This article presents a case of a 25-year-old man whose diagnosis of patellar tendon rupture was delayed by 1 year. The patella was mobile and could be brought down to its original position manually. The patellar tendon was successfully reconstructed with autogenous semitendinosus and gracilis tendon graft. No preoperative or intraoperative traction was used on the patella. Quadriceps lengthening was not performed and no hardware was used between the patella and the tibia to augment the reconstruction. Scar tissue was not excised and was used to cover the hamstring tendons. The patient achieved a good functional result after 5 months of rehabilitation. At 14-month follow-up, the patient had returned to his pre-injury level of work with no deterioration of knee function.     

An undescribed cause of patellar tendon rupture

We present a rare case of a myxoid-feature lipoma that arose in the patella fat pad and caused patellar tendon rupture.     

Repeat patellar tendon rupture in a child

In summary, we present the first published case of a patellar tendon midsubstance rupture in an otherwise healthy 9-year-old with repeat rupture at age 10.     

Bilateral simultaneous rupture of the patellar tendon

Summary A case of bilateral simultaneous rupture of the patellar tendon due to apicitis patellae is presented. Clinical picture, diagnosis, pathogenesis and treatment are discussed. In addition, the literature on the subject is reviewed.     

Old rupture of the patellar tendon. A case report

A 46-year-old man with pain and instability in the right knee and a long-neglected rupture of the patellar tendon was treated by means of tendon reconstruction. External skeletal fixation between the patella and the tibial tubercle allowed for early exercise of the knee joint, resulting in a favorable range of knee motion. This method is considered to be helpful in the reconstruction of old and disabling patellar tendon ruptures.     

Bilateral metachronous rupture of the patellar tendon.

We present a case of a 37-year-old man who sustained a rupture of his left patellar tendon approximately 48 hours after rupturing his right patellar tendon. This temporal pattern illustrates two important aspects of patellar tendon injury-that rupture of the degenerated patellar tendon may occur without any prodromal warning and that it may elude detection even if the patient is examined by several physicians.     

Repair of patellar tendon rupture using suture anchors

Acute isolated rupture of the patellar tendon traditionally has been repaired via transpatellar suture tunnels. This retrospective study evaluated the demographics and epidemiology of this injury as well as the effectiveness and complication rates of our suture anchor technique. Between 1993 and 2005, a total of 82 cases of patellar tendon disruption in 71 patients were repaired. Fourteen cases involved basic primary repair with suture anchors of an acute isolated rupture of the patellar tendon and had an average follow-up of 29 months (range: 3-112 months). There were 3 (21%) failures of repair. The remaining 11 patients had excellent range of motion and strength and returned to their preoperative level of function. These results are comparable with other reports in the literature. The suture anchor technique thus represents a viable option for repair of patellar tendon ruptures and should be investigated further with a randomized, controlled trial.     

A new technique of harvesting patellar tendon autografts for anterior cruciate ligament reconstruction.

A new surgical technique to uniformly harvest the middle one-third of the patellar tendon for anterior cruciate ligament reconstruction is described. The technique uses a guide system of 8 templates of varying widths to guide the saw cuts and "collared," depth-controlled saw blades and drill bits to produce a standard cutting and drilling depth. This kind of template system lessens the risks of graft harvesting complications such as patella fracture, bone graft fragmentation, suture pull out, and judgment errors pertaining to graft depth, length, or width. The Patellar Tendon Graft Guide was used to obtain a patellar tendon graft in 65 patients. Fifty-nine arthroscopic-assisted and 6 open anterior cruciate ligament reconstructions were performed. Of the 65 grafts harvested, 63 consistently demonstrated bone portions 20 mm in length, 7 mm in depth, and a width corresponding to the template chosen (usually 10 mm). Two grafts supposed to be 10 mm in width turned out to be 9 mm in width because of a technique related problem.     

Acute distal biceps tendon rupture--a new surgical technique using a de-tensioning suture to brachialis

Acute distal biceps rupture is a devastating injury in the young athlete and surgical repair offers the only chance of a full recovery. We report a new surgical technique used in 14 cases of acute distal tendon rupture in which the 'suture anchor technique' and a de-tensioning suture was employed. In this procedure the distal end of the biceps is re-attached to the radial tuberosity using a sliding whip stitch suture and the proximal part of the distal tendon repair attached to the underlying brachialis muscle with absorbable sutures. This restores correct anatomical alignment and isometric pull on the distal tendon and de-tensions the repair in the early post-operative period, allowing early rehabilitation and an early return to activity. In all cases patients regained a full pre-injury level of sporting activity at a mean period of 6.2 months (2-9 months).