Surgical Treatment of Chronic Patellar Tendon Rupture: A Case Series Study

Abstract

Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon ruptures. Methods: This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, presenting twelve cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18 -58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3 -132). The mean time of follow-up was 6.2 years (range 3 -9). Cerclage wire reinforcements were applied in nine of the knees and the left three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Clinical Outcomes are Similar Between Graft Types Used in Chronic Patellar Tendon Reconstruction: A Systematic Review

“…Two studies were excluded because of insufficient reporting of patient demographics and outcomes, 18,33 two studies were excluded due to inadequate follow-up, 6,16 and 35 studies were excluded due to being level V evidence, 4,5,7,[9][10][11][12][13]15,[17][18][19][20]22,24,25,[27][28][29][30][31][33][34][35][36][37][38][39][40][41][42]44,[46][47][48][49][50] leaving 9 studies for inclusion in our review. 3,8,14,21,23,26,32,43,45 All of the included studies were case series.…”

“…3 Range of motion was reported qualitatively as comparable to contralateral 3 and numerically with mean 1-128 . 14,21,23,32,43 Mean extensor lag was 1.5 . 21,43 Quadriceps strength was reported qualitatively as comparable to contralateral.…”

“…14,21,23,32,43 Mean extensor lag was 1.5 . 21,43 Quadriceps strength was reported qualitatively as comparable to contralateral. 23 Thigh girth was reported numerically as mean 1.5-cm difference compared to contralateral.…”

“…3,23,43 International Knee Documentation Committee (IKDC) score improved by mean 50.5 points. 21,43 Visual analog scale improved by 1.6 points. 14 Cincinnati Knee Rating System (CKRS) improved by mean 50.8 points.…”

Reconstruction of chronic patellar tendon rupture with hamstring graft and SS wire augmentation: A case report

“…Surgical management of neglected patella tendon tear are often challenging owing to the proximal retraction of patella due to unopposed quadriceps contraction (4). More over the mechanical load over reconstructed patellar ligament is enormous and hence protecting the surgical reconstruction and achieving a successful functional outcome is demanding task (4). It is imperative to provide a robust reconstruction assisted with a good augmentation procedure which would allow early mobilization (4).…”