Staged patellar tendon reconstruction using doubled bone-patellar tendon-bone allograft for infected patellar tendon rupture: a rare case report of three years follow-up

Abstract

Background Patellar tendon rupture is a relatively rare injury that usually requires surgical treatment. The optimal therapeutic strategy is still controversial, especially when either concomitant patellar tendon infection or soft tissue infection surrounds the patellar tendon. Until recently, most reported reconstruction methods are extensive and difficult to apply because of the poor condition of the soft tissue surrounding the patellar tendon. Case presentation A 19-year-old male patient presented to our clinic three weeks following a motorcycle accident. There was a 5 x 4 cm sized skin defect with soft tissue infection below the inferior pole of patella. We performed a staged patellar tendon reconstruction using a doubled bone-patellar tendon-bone allograft (BPTB) to the infected patellar tendon rupture, following local random fasciocutaneous flap and split-thickness skin graft. Three months following surgery, the patient was able to perform an active knee motion with no extension lag and excellent clinical functional result. Discussion and conclusions Our technique introduced in this specific case is a relatively simple method to reconstruct chronic patellar tendon defects with limited incision exposing only the patellar tendon areas. We expect it can be less invasively performed on patients who have a soft tissue problem and cannot have extensive surgery.

Delayed Allograft Reconstruction and Heterotopic Bone Excision of Chronic Neglected Patella Tendon Avulsion in an Adolescent

“…Longitudinal patella drill holes, with suspensory fixation on the superior patella cortex, could also be used to fix the grafts if the morphology of the patella will accommodate without fracture [12]. Achilles tendon, on-lay, allograft could be used as well [13,14].…”

Patellar Tendon Repair Using a Patellar Tendon Allograft and External Fixator in Three Dogs

“…11,12 One appealing characteristic of an allograft is that there is a lower likelihood of a second surgery to remove the allograft, when compared with circumpatellar or transpatellar wires that frequently break and require removal. 2,8 Other potentially advantageous characteristics of allograft use include a lack of donor site morbidity, probable superior strength in comparison to autologous fascia lata 5 and the possibility that with infection the allograft might not need to be removed, 16 which contrasts with non-biologic materials. One potential advantage of a patellar tendon allograft versus a common calcaneal tendon allograft is that the patellar tendon allograft is more closely anatomically shaped to the native patellar tendon, potentially making its surgical implantation easier.…”

“…There are multiple reports on successful application of patellar tendon allografts for patellar tendon reconstruction in people including with an infected patellar tendon rupture. [16][17][18] Potential disadvantages of allograft use include the cost and risk of disease transmission or immune-mediated reaction. 11 Risk of disease transmission or immune-mediated rejection is mitigated by screening of donor tissues for infectious disease and graft preparation which renders it acellular and typically non-immunogenic.…”

Treatment of Distal Patellar Tendon Chronic Rupture: The X-Wave Technique

“…4 Additionally, in the cases of chronic PT rupture, different techniques involving auto or allograft augmentation, reinforcement, and combination of other varying fixation devices were described aiming to appropriately correct the patella height and restore soft tissue integrity. [7][8][9][10] The low incidence of distal PT rupture and the variety of injury patterns turns an individual approach based on the intraoperative findings and in the surgeon's experience, reasonable. Our purpose is to describe a surgical technique to restore the knee extensor mechanism after chronic distal soft-tissue PT avulsion, using two kinds of graft, one as a waveform augmentation of the native tendon and the other as reinforcement in letter X aspect.…”