Outcomes and Complications Following Chronic Patellar Tendon Repair: A Systematic Review

Abstract

The purpose of this systematic review is to report outcomes and complications following the reconstruction of chronic patellar tendon ruptures. Four databases (Cochrane Database of Systematic Reviews, PubMed, Embase, MEDLINE) were searched from inception to July 2021. Inclusion criteria included articles that (1) analyzed outcomes and complications following chronic patellar tendon reconstruction (>4 weeks from injury to repair), (2) were written in English, (3) greater than five patients, and (4) a minimum 2-year follow-up. Exclusion criteria included (1) non-original research and (2) patellar tendon repair/reconstruction with prior total knee arthroplasty. Data on outcome metrics and complications were extracted from the included studies and reported in a qualitative manner. Nine studies (number of patients = 96) were included after screening. Seven studies analyzed autograft reconstruction, and three of those seven studies analyzed reconstructions with additional augmentation. The remaining two studies evaluated reconstruction utilizing a bone-tendon-bone (BTB) allograft. Four of the autograft studies (n=40 patients) showed a range of post-operative mean Lysholm scores of 74-94. Additionally, four studies reported a post-operative extensor lag of 0-3°. Post-operative protocol for autograft studies included delayed motion and was either contained to a bivalved cast or a hinged knee brace for six weeks. The two allograft studies reported a range of mean Lysholm scores from 62 to 67, and each immobilized the leg in full extension until six weeks. While chronic patellar tendon ruptures are a rare injury of the extensor mechanism, there are viable options for reconstruction. Overall, chronic patellar tendon ruptures reconstructed with both autograft and allograft will provide fair to good outcomes with low complication rates. Following surgery, immobilization for at least six weeks should be emphasized to protect the graft and optimize patient outcomes.

Patellar Tendon Reconstruction After Failed Primary Repair of Bilateral Ruptures

“…B ilateral PTR is a severe injury with significant impact on patients' private and professional lives 6 . It was recently demonstrated that the use of suture anchors compared with transosseous sutures can decrease the rerupture rate 7 .…”

Injectable self-assembled GDF5-containing dipeptide hydrogels for enhanced tendon repair

“…Tendons are important tissues that connect muscles and bones and play roles in transmitting strength and maintaining body movement [ 1 , 2 ]. Tendons are prone to injury owing to various conditions, such as excessive exercise, trauma, diabetes, aging, and even rupture, leading to pain and motor dysfunction [ 3 , 4 ]. Moreover, tendon tissues are characterized by poor cellularity and vasculature, which hinder and complicate the healing of tendon injuries [ 5 , 6 ].…”

“…Conservative treatment requires a long recovery period and often fails to fully restore tendon structure and function [ 11 ]. Although surgical repair can better address injured tendons, postoperative complications and tendon adhesion also occur [ 4 , 12 ]. Therefore, the effective repair of injured tendons and promotion of tendon regeneration have become important and challenging issues in this field in recent years.…”