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.     

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.

     

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.     

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.     

Diagnosis and treatment of closed complete rupture of patellar tendon. Analysis of 11 cases]

Eleven cases of closed complete rupture of patellar tendon (4 neglected ruptures and 7 fresh ruptures) were treated. Seven of them were treated in extension for 6-8 weeks after operation, 1 was immobilized with patellar traction in the early stage on bed, and 3 were mobilized and assisted with movable brace standing and walking through the body weigh on the knee in the early stage after operation. The aim was to promote the functional recovery of the knee joint. The mechanism of injury, clinical diagnosis, treatment and rehabilitation of closed rupture of patellar tendon were discussed in combination with clinical experience. And the suggestion of movement and active recovery in the early stage after patellar tendon surgery was put forward.     

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.     

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.     

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。     

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.     

Re-revision of a patellar tendon rupture in a young professional martial arts athlete

A 27-year-old professional martial arts athlete experienced recurrent right knee patellar tendon rupture on three occasions. He underwent two operations for complete patellar tendon rupture: an end-to-end tenorrhaphy the first time, and revision with a bone-patellar-tendon (BPT) allograft. After the third episode, he was referred to our department, where we performed a surgical reconstruction with the use of hamstring pro-patellar tendon, in a figure-of-eight configuration, followed by a careful rehabilitation protocol. Clinical and radiological follow-ups were realized at 1, 3, and 6 months and 1 and 2 years postop, with an accurate physical examination, the use of recognized international outcome scores, and radiograph and MRI studies. As far as we know, this is the first paper to report a re-revision of a patellar tendon rupture.     

Patellar and quadriceps tendon ruptures

Ten cases of rupture of quadriceps tendon and seven cases of rupture of the patellar ligament were studied. All patients were reexamined. One must differentiate between rupture of the quadriceps tendon (tendon ruptures in elderly patients with degeneratively changed tendon in trivial trauma) and rupture of the patellar tendon (tendon rupture in younger patients with considerable trauma). All the patients were discussed with regard to accident mechanism, histology, underlying systemic and local diseases, therapy and results. There were good results in all patients with rupture of the patella tendon. In seven of the ten patients with quadriceps tendon rupture, we noted also good results. Three patients had residual pain and restricted motion and function of the knee. In two of these cases, diagnosis and reconstruction was delayed for months, the other patient had an infection of an implanted knee endoprosthesis in the injured knee.     

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     

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.     

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.     

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.     

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.     

Patellar tendon ruptures in weight lifters after local steroid injections

Introduction  Weight lifting is commonly associated with an increase in knee injury risk. Local steroid injection is thought to be associated with increased risk of spontaneous tendon rupture. The purpose of this report is to describe incidence of rupture of the patellar tendon after receiving multiple local steroid injections in weight lifters. Materials and methods  Seven weight lifters presented at the hospital with ruptured patellar tendon. All the patients had a history of multiple local steroid injections into the patellar tendon. Each patient received surgical treatment within 72 h after injury. Results  After an average follow-up time of 26 months, the mean postoperative Lysholm knee score was 94 and the mean Insall-Salvati measurement was 0.96. All seven athletes returned to weight lifting training at 1 year after the operation. They returned to full competition at 18 months after the surgery. Conclusion  For physicians who treat patellar tendonitis, especially in weight lifters, it is important to recognize the contributing factors for tendon rupture especially in those who have had multiple steroid injections. The functional prognosis of the knee improves if the normal length and strength of the injured tendon have been properly restored.     

Use of a turndown quadriceps tendon flap for rupture of the patellar tendon after total knee arthroplasty

Patellar tendon rupture is a devastating complication after total knee arthroplasty. The results of surgical treatment of this complication were discouraging in most of the reports. We describe a case of rupture of patellar tendon 7 weeks after total knee arthroplasty treated with a turndown quadriceps flap and circumferential wiring. Two years and 6 months after operation, the patient had no extension lag of the knee and knee flexion to 110 degrees .     

Simultaneous rupture of the quadriceps tendon with contralateral patellar tendon rupture: an unusual case and a review of the literature

Simultaneous rupture of quadriceps tendon with contralateral patellar tendon is very rare. There are only two case reports in English literature. We report the case of a healthy 41-year-old female with simultaneous rupture of her left quadriceps tendon and right patellar tendon. There were no known precipitating factors for this injury. Surgical repair and early rehabilitation achieved satisfactory outcome.     

Management of extensor mechanism disruptions occurring after total knee arthroplasty

Extensor mechanism disruption from quadriceps tendon rupture, patellar fracture, or patellar tendon rupture is an uncommon complication of total knee arthroplasty. Extensor mechanism disruption can occur either intraoperatively or postoperatively. Common intraoperative causes include avulsion or tendon injury arising from excessive tension during surgical exposure, improper patellar resection, and devascularization due to injudicious lateral retinacular release or multiple prior surgeries. The usual postoperative causes are tissue necrosis arising from infection, component malalignment, and trauma. A wide range of treatment options is available for managing these difficult problems, and recent advances in alternative techniques for reconstruction have yielded promising results.