Simultaneous complete bilateral patellar tendon ruptures: two cases and literature review

Infra-patellar tendon is the least common site for the disruption of extensor mechanism of knee joint. Bilateral simultaneous patellar tendon ruptures are very rare and extremely uncommon in healthy individuals. We report two cases of simultaneous complete bilateral patellar tendon ruptures, one in a healthy adult male and the second in a patient suffering from chronic rheumatoid arthritis. To the best of our knowledge, this report represents the third reported case of bilateral simultaneous patellar tendon rupture in rheumatoid arthritis. Rarity of bilateral ruptures and symmetry of physical findings may make the diagnosis difficult. Early surgical repair gives excellent results. Relevant literature is reviewed.     

Spontaneous bilateral patellar tendon rupture: a case report and review of the literature

Bilateral rupture of the patellar tendon is a very rare injury. It occurs in association with chronic systemic diseases or corticosteroid medications. We report a case of a 13-year-old child with Ehlers-Danlos syndrome presenting a bilateral patellar tendon disruption of proximal insertion that occurred with a trivial trauma. Surgical management consisting in tendon repair with a suture anchor technique protected temporarily with a cerclage wiring gives a good outcome.     

Neglected spontaneous bilateral rupture of the patellar tendon: a case report

A patient taking corticosteroids for rheumatoid arthritis experienced a spontaneous bilateral rupture of the patellar tendon. Initially neglected, the rupture was repaired surgically by tendinoplasty using the semitendinous tendon for the right knee and inversion of the quadriceps tendon for the left. Functional results were similar. On the right knee, the wire cerclage loosened leading to posterior sagittal displacement of the patella, pointing out the difficulties encountered when repairing neglected rupture of the patellar tendon. Due to the small number of cases and difficulties in assessing the techniques proposed, no large-scale series has been reported in the literature.     

Bilaterale Ruptur des Lig.patellae bei Diabetes mellitus

Bilateral ruptures of patellar tendon are a rare event and occur mainly in older patients suffering from systemic diseases like lupus erythematosus, chronic renal failure, rheumatoid arthritis or are taking longterm corticosteroids. Only few cases of spontaneous bilateral rupture of patellar tendon without underlying systemic disease are described in literature up to now. This report provides a patient with bilateral patellar tendon rupture, where in further check up and follow up only a mild diabetes mellitus treated by diet could be detected as systemic disease. In current opinion diabetes mellitus does not belong to the "typical" underlying systemic diseases for tendon ruptures. In literature research diabetes mellitus was only mentioned once together with a bilateral patellar tendon rupture.     

保留止点半腱肌、股薄肌肌腱重建修复陈旧性髌韧带断裂2例报告

目的探讨利用保留止点半腱肌、股薄肌肌腱重建修复陈旧性髌韧带断裂的的治疗方法和疗效。方法采用保留止点半腱肌、股薄肌腱横穿髌骨隧道后重叠缝合重建髌韧带并加用减张钢丝固定方法治疗2例陈旧性髌韧带断裂。结果2例患者均得到随访,分别随访18个月与24个月。术后2、3、6、12、18个月及2年分别对2例病人进行Lysholm评分,术后1年平均分达到80分以上,显示治疗结果为优。结论对于陈旧性髌韧带断裂患者,取半腱肌及股薄肌对其加强重建辅以钢丝内固定手术为临床操作方便、疗效较为可靠的方法。     

Reconstruction of bilateral spontaneous chronic idiopathic Achilles tendon rupture using LARS ligament: Case report

Spontaneous bilateral idiopathic rupture of Achilles tendon is rare and usually results from sudden dorsiflexion of a plantar-flexed foot; the tendon is most often degenerated or diseased, and spontaneous bilateral rupture is not rare in patients suffering from chronic diseases. Management problems relate to reconstruction options and issues with early ambulation and weight bearing. We report a case of idiopathic bilateral Tendo-Achilles (TA) rupture with no obvious disease process, which was initially neglected, and subsequently reconstructed with LARS polyester ligament. The patient could be mobilized early despite bilateral involvement, but developed bilateral wound dehiscence which needed debridement and local flap coverage; aggressive rehabilitation finally leads to an excellent functional outcome. Despite the fact that artificial ligaments allow biointegration and can withstand stresses of early weight bearing, they often lead to wound related problems. Judicious use is advocated and good cases for their use maybe bilateral TA repair in neglected tears with gaps.     

Quadriceps and patellar tendon ruptures

Ruptures of the quadriceps as well as the patellar tendon occur in low frequency, but cause major functional deficits of the leg. These injuries usually require operative treatment. Acute quadriceps tendon ruptures are treated by suture repair, using heavy sutures guided through bone tunnels in the patella. Chronic defects and neglected cases require a local tendon transfer, either by a quadriceps tendon turn-down or by a V-Y-plasty of the quadriceps tendon. Ruptures of the patellar tendon are treated by suture of the tendon stumps plus an reinforcement procedure protecting the tendon and avoiding secondary patella alta. Patello-tibial fixation may be achieved by a cerclage technique using wire or an autologous tendon strip, alternatively a patello-tibial external fixator can be applied. In chronic and neglected cases, patellar tendon reconstruction is performed with autologous tendon grafts or with soft tissue allografts. The graft must be protected by a patello-tibial fixation for the first weeks.     

Intra-operative patellar fracture during chronic patellar tendon rupture reconstruction: salvage and prophylactic modified techniques

Management of chronic neglected patellar tendon rupture represents a challenging condition for the orthopedic surgeons to deal with due to many factors such as quadriceps muscle atrophy, superior migration of the patella, e.g., patella alta, peri-patellar adhesions and patellar tendon atrophy. Such difficulties might be further complicated by intra-operative patellar fracture during patellar tendon reconstruction. In the current article, the authors report (1) a salvage procedure for such devastating intra-operative complication, based on bypassing the patella and gaining the advantage of the quadriceps tendon for structural and functional restoration of the knee extensor mechanism, and (2) prophylactically a technical modification of patellar tendon reconstruction guarding against such inadvertent patellar fracture.

     

New modified Achilles tendon allograft for treatment of chronic patellar tendon ruptures following total knee arthroplasty

Introduction

Patellar tendon rupture is an infrequent but debilitating lesion. Several surgical repairs have been suggested for patellar tendon rupture. Our aim is to propose a modified technique from the classic Achilles allograft procedure.

Materials and methods

Five consecutive patients diagnosed with chronic patellar tendon rupture following total knee arthroplasty (TKA) were included in the presented study. All patients were operated with a modified Achilles allograft technique, dividing the Achilles tendon into two bundles and overcrossing these through the distal part of the quadricipital tendon.

Results

All patients regained their extension mechanism and have discontinued using crutches. No complications were observed.

Conclusions

The modified Achilles allograft has shown to be a safe, time-reducing repair for chronic patellar tendon ruptures following TKA, and should be considered as an alternative surgical repair.     

Advanced osteoarthritic knee with neglected patellar tendon rupture treated with total patellectomy and total knee arthroplasty

Loss of the knee extensor mechanism results in a change of normal knee joint alignment and functional anteroposterior instability. In patients with neglected or chronic patellar tendon rupture, advanced degenerative change of the knee joints may develop at the later stage. We present a case of a 64-year-old man with chronic left patellar tendon rupture and 10-cm proximal patella migration associated with advanced osteoarthritis of the knee. Total patellectomy and simultaneous total knee arthroplasty (TKA) relieved his symptoms and disability successfully. His left knee still did well at 7-year follow-up.     

Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.     

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.     

Gleichzeitige Patella- und kontralaterale Quadrizepssehnendurchtrennung

The simultaneous bilateral rupture of the quadriceps tendon is a rare injury; only occasional reports exist about the bilateral simultaneous rupture of the patellar tendon. Degenerative changes of the tendon due to drugs or diseases lead to the rupture. We describe two cases of simultaneous rupture of the patellar and contralateral quadriceps tendons; only one patient had special risks. We report the management of therapy and the functional results using the Lysholm score and Knee Rating Scale.     

Rupture of the quadriceps tendon: an association with a patellar spur

We reviewed the records of 107 consecutive patients who had undergone surgery for disruption of the knee extensor mechanism to test whether an association existed between rupture of the quadriceps tendon and the presence of a patellar spur. The available standard pre-operative lateral radiographs were examined to see if a patellar spur was an indicator for rupture of the quadriceps tendon in this group of patients. Of the 107 patients, 12 underwent repair of a ruptured patellar tendon, 59 had an open reduction and internal fixation of a patellar fracture and 36 repair of a ruptured quadriceps tendon. In the 88 available lateral radiographs, patellar spurs were present significantly more commonly (p < 0.0005) in patients operated on for rupture of the quadriceps tendon (79%) than in patients with rupture of the patellar tendon (27%) or fracture of the patella (15%). In patients presenting with failure of the extensor mechanism of the knee in the presence of a patellar spur, rupture of the quadriceps tendon should be considered as a possible diagnosis.     

Atraumatic bilateral patellar tendon rupture in a patient receiving steroid therapy

Atraumatic bilateral patellar tendon rupture is a rare entity. It is usually due to systemic or local disorders causing tendon degeneration. Early diagnosis and surgical treatment are crucial for recovery of knee functions. Atraumatic bilateral patellar tendon rupture was diagnosed in a 31-year-old female patient who had been receiving steroid therapy for seven years due to systemic lupus erythematosus. She underwent patellar tendon reconstruction with the use of semitendinosus and gracilis tendons. After a follow-up of six months, she could walk without crutches and had a full range of motion.     

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.     

Simultaneous bilateral quadriceps tendon rupture in patient with chronic renal failure

Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.     

Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature

Knee extensor mechanism disruption is a serious injury usually requiring emergent treatment. Rupture of the patellar tendon is rare in the normal population; bilateral spontaneous concurrent rupture in a healthy population is an exceptional event. We describe the case of a 39-year-old man with bilateral spontaneous concurrent rupture of the patellar tendon without any underlying systemic disease or drug use.     

Patellar Tendon Ruptures

Rupture of the patellar tendon is a relatively infrequent, yet disabling, injury, which is most commonly seen in patients less than 40 years of age. It tends to occur during athletic activities when a violent contraction of the quadriceps muscle group is resisted by the flexed knee. Rupture usually represents the final stage of a degenerative tendinopathy resulting from repetitive microtrauma to the patellar tendon. This injury may also occur during less strenuous activity in patients whose tendons are weakened by systemic illness or the administration of local or systemic corticosteroid medications. The diagnosis is made on the basis of the presence of a painful, palpable defect in the substance of the tendon; an inability to completely extend the knee against gravity; and the existence of patella alta confirmed by lateral radiographs. Ultrasonography and magnetic resonance imaging are useful in identifying a neglected rupture, as well as when the diagnosis is in question or an intra-articular injury is suspected. The prognosis after a patellar tendon rupture depends in large part on the interval between injury and repair. Surgery soon after the injury is recommended for optimal results. This is best accomplished by accurate reapproximation of the ruptured tendon ends, repair of the torn extensor retinacula, and placement of a reinforcing cerclage suture. An aggressive rehabilitation program, emphasizing early range-of-motion exercises, protected weight bearing, and quadriceps strengthening, will enhance the results of surgery. Patients who undergo delayed repair are at risk for a compromised result secondary to loss of full knee flexion and decreased quadriceps strength, although a functional extensor mechanism is likely to be reestablished.     

Neglected Achilles tendon rupture with central insertional plantaris tendon hypertrophy: two cases

A neglected Achilles tendon rupture is often characterized by muscle weakness and an overlengthened repair by scar tissue. Reconstructive surgery is usually performed taking into account the patient’s required level of function. Two surgical cases of neglected Achilles tendon rupture are presented in this article. In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found. However, after longitudinal opening of the tendons, a thickened plantaris tendon was evident at the insertion on the calcaneus in both cases. This hypertrophic tendon occupied most of the diameter of the Achilles tendon. Due to partial or complete rupture of the Achilles tendon, there was notable weakening and tendon transfer-augmentation was performed. A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation. It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized.