Treatment of a Neglected Patellar Tendon Rupture with a Modified Surgical Technique: Ipsilateral Semitendinosus Autograft Reconstruction with Suture Tape Augmentation

Abstract

Patellar tendon ruptures are rare, but debilitating injuries are typically seen in young active males in the third and fourth decades of life. They can occur as a single acute injury or from repetitive microtrauma weakening the tendon. Patients typically present complaining of knee pain, swelling, and an inability to perform a straight leg raise. Most conventionally, these injuries are classified as acute (less than two weeks) or chronic (greater than two weeks) based upon the timing of presentation. In patients with patellar tendon ruptures and inability to perform a straight leg raise, patellar tendon repair is most often recommended. A subset of patients with chronic patellar tendon ruptures, however, presents several months after their initial injuries. These neglected patella tendon ruptures present a particularly challenging clinical scenario in which primary repair is often difficult or not possible. This case report describes a modification to an existing surgical technique for reconstructing the patellar tendon using an ipsilateral semitendinosus tendon autograft with suture tape augmentation.

Distal Patellar Tendon SpeedBridge Repair

“…20 Anatomic double-row repairs have been shown to have higher fixation strength than single-row and point-fixation constructs in triceps and rotator cuff repair. 3,21 These methods also show minimal gap formation and favorable loads to failure. We endorse speed-bridge repair of distal patellar tendon avulsion injuries, which provides numerous benefits over traditional methods (Table 2).…”

“…Biomechanical studies have shown that forces across the extensor mechanism are highest at 60 of flexion and that up to 17.5 times body weight in force is necessary to cause patellar tendon rupture. 3,13 The Ogden classification is commonly used to describe these injuries and their variations in intra-articular extension, tuberosity comminution, and displacement. 14 Frankl et al 15 modified the classification to add a subtype with associated distal patellar tendon avulsion.…”

“…Additionally, the Siwek and Rao classification 16 of patellar tendon ruptures divides the injuries into acute and chronic groups, which can be helpful in predicting outcomes because early intervention has been shown to lead to improved function. 2,3 The evolution of suture anchors and their improved designs have changed the way surgeons are able to approach tendon repair. Mirroring the advances in rotator cuff repair, the innovation of modern suture anchors and high-strength suture material has allowed the use of strong repair constructs for injuries to other tendons such as the Achilles and triceps.…”

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

“…Improvements in the International Knee Documentation Committee score and Lysholm score from 45 to 64.5 and from 45.4 to 79, respectively, were obtained, both of which were statistically significant; none of the patients had a preoperative Caton-Deschamps index greater than 2. In 2018, Samagh et al 26 published a case report describing a technique for reconstruction of the patellar tendon in patients with chronic injuries. In the patient described, the selfreported Caton-Deschamps index was greater than 1.2 and the injury had occurred 5 months earlier.…”

Patellar Tendon Reconstruction Using Hamstring Tendon and Adjustable Suspensory Cortical Fixation

“…Several alternative techniques have been reported, but no large series exist and late treatment of patellar tendon rupture is still controversial. Contralateral bone-tendon-bone graft, 5 ipsilateral gracilis and semitendinosus graft,1, 6 artificial ligament,7, 8 and allograft9, 10 have been described for this surgical procedure. The influence of graft choice on knee function has not been evaluated.…”