Patellar Tendon Reconstruction Using Hamstring Tendon and Adjustable Suspensory Cortical Fixation

Abstract

Chronic patellar tendon rupture is a rare injury; extensor mechanism impairment leads to great disability in daily life. The delayed diagnosis and reconstruction of chronic patellar tendon ruptures are technically challenging. Numerous surgical procedures have been described with bone-tendon-bone graft, hamstring graft, artificial ligament, and allograft. We describe safe, reproducible anatomic reconstruction of the patellar tendon using hamstring tendon and adjustable suspensory fixation. After harvesting of the hamstrings, the graft is prepared with 2 adjustable suspensory fixation devices. Then, a complete tibial tunnel and a patellar tunnel with a socket are drilled with the appropriate diameter, and the graft is pulled through the tunnels. Finally, the suspensory fixation devices on the tibial and patellar sides are tensioned. The aim of this procedure is to obtain complete mobility of the knee, using a procedure similar to anterior cruciate ligament reconstruction in graft preparation.

Patellar Tendon Reconstruction for a Chronic Extensor Mechanism Deficit Using an Achilles Tendon Allograft With Hamstring Autograft and Suture Augmentation

“…Previously described reconstruction techniques include use of autografts, allografts, xenografts, and synthetic material, as well as combinations of thereof. [8][9][10] McNally and Marcelli 11 as well as Falconiero and Pallis 12 described reconstruction techniques using an Achilles allograft augmented with a suprapatellar tension-band wire with a subsequent operation to remove the wire. George and Jorgensen 13 described a reconstruction technique using an Achilles tendon allograft bone plug that was shaped to press fit into a tunnel in the tibial tubercle and secured with a biocomposite interference screw.…”

“…When direct repair of the tendon is not possible, the tendon is augmented using either allografts or autografts. 1,[4][5][6][7][8][9] In the absence of any viable patellar tendon tissue, a reconstruction is necessitated. Because chronic patellar tendon injuries are rare, there is no consensus on the optimal approach for treatment.…”

Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages

“…27 Reconstruction of the patellar tendon using adjustable suspensory fixation has been reported for the treatment of chronic lesions. 28 The authors of this technique advocated the use of autologous semitendinosus and gracilis grafts. The grafts are bent multiple times, with the final graft measuring 10 to 12 cm long and 8.5 to 10 mm thick.…”

Age over 50 does not predict results in anterior cruciate ligament reconstruction.

“…A growing body of evidence has broadly changed the approach of the surgeons toward the management of the ACL tears in middle-aged patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Several systematic reviews and meta-analysis 19,20 have demonstrated that ACL reconstruction for patients older than 40 years could have comparable clinical outcomes as younger patients, including a greater return to sport activity. Moreover, although few studies have evaluated the outcomes of ACL reconstruction in patients with a cut-off of older than 50 years, a systematic review and a meta-analysis recently claimed that age was no longer a criterion contraindicating ACL reconstruction.…”

“…Recently, there was a growing of studies that encourage the surgical approach in this population and these evidences could help surgeons with patient selection and adjusting expectations [5][6][8][9][10][11][12][13][14] At the same time, some surgeons Age over 50 does not predict results in anterior cruciate ligament reconstruction.Orthopedic Reviews…”