Treatment of Chronic Patellar Tendon Rupture with Hamstrings Tendon Autograft

Abstract

<jats:title>Abstract</jats:title><jats:p>We describe a new simple reconstruction for neglected chronic ruptures of patellar tendon using ipsilateral hamstrings tendon autograft. This has been validated in thirteen patients with mean follow up six years resulting in favorable outcome. Thirteen patients with mean age 58.2 years (range 30–64 years) presented with chronic patellar tendon rupture. They all underwent patellar tendon reconstruction using ipsilateral hamstrings tendon autograft. The average time from injury was 10 months (range 3–20 months). The cause of rupture was fall from height or after TKA and the preoperative Lysholm score was 65 (range 50–80). Postoperatively with a mean follow up of six years (range 5–7 years), all patients had a stable knee with mean flexion of 123°, extension lag 0°, and Insall-Salvati index 1.2. Quadriceps power was regained in 8 cases to 5/5 and in 5 cases to 4/5. No complications were inspected. The postoperative Lysholm score was 93 (range 89–95). Patellar tendon reconstruction using ipsilateral hamstrings as free autograft, consists an effective treatment option for chronic neglected patellar tendon ruptures. Our technique has favorable clinical outcome, complications are not expected, and consist a simple and anatomic reconstruction with a powerful graft, without the requirement for allograft or implants.</jats:p>

Extensor Mechanism Reconstruction for Chronic Patellar Tendon Tears

“…The 10 studies were published between 2013 and 2019 and encompassed a total of 105 knees from 103 patients 3–5,10,14–19 (Table 1). Two studies 14,18 were level III studies and the remaining eight were level IV studies 3–5,10,15–17,19 . The average risk of bias using the MINORS criteria was 9.3 for the nine noncomparative studies, as opposed to 18.5 in the lone comparative study 14 …”

“…The mean age for the included patient population was 40.3 years (range 18–87). Of the seven studies reporting sex, 80.9% of the patients were male and 19.1% were female 3–5,10,17–19 . The mean follow-up length was 53.8 months (range 12–144 months).…”

“…In the seven studies using hamstring autografts, the graft was most commonly passed through two transverse tunnels, one in the patella and one at the level of the tibial tubercle. The hamstring graft was passed and anchored in a variety of ways: in a figure-eight pattern in four studies; 3,4,10,17 in a percutaneous-approach circular pattern by Jain et al; 16 and using vertical tunnels with a button to anchor the proximal portion of the hamstring graft in the patella and two side holes exiting the distal vertical tunnel to pass the suture to anchor the graft distally 19 . Three studies 3,10,14 mention McLaughlin cerclage wires, and the authors of two of these studies elected to remove the wires at either 6 14 or 9 weeks 3 …”

“…Complication data were reported across six studies (71 knees from 69 patients) 3–5,10,16,17 . The remaining studies did not report complications 14,15,18,19 . No major complications or failures were reported.…”

“…Following full-text review, eight papers were identified for final inclusion. Subsequent review of the references of these papers yielded two additional studies for inclusion, bringing the final number to 10 publications [3][4][5]10,[14][15][16][17][18][19].…”