Skip to main content
SpringerLink
Log in

Early combined arthroscopic treatment for simultaneous ruptures of the patellar tendon and the anterior cruciate ligament leads to good radiological results and patient satisfaction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Simultaneous rupture of the patellar tendon (PT) and the anterior cruciate ligament (ACL) is a relatively rare injury. This study offers a comprehensive review of the published reports and presents two cases of simultaneous PT and ACL rupture.

Methods

A systematic review of English literature was performed, and data from two patients who were referred to our institution with simultaneous PT and ACL rupture were collected. Both patients underwent primary arthroscopic ACL reconstruction combined with PT reconstruction and, 1 year after surgery, magnetic resonance imaging (MRI), clinical examination, strength measurement and functional assessment.

Results

Fourteen studies (24 patients) were included in the review. A two-stage approach was used in eight cases (33.3%), and in nine the use of arthroscopy was documented (37.5%). Post-operative scores were documented for nine patients (average IKDC 91.2; Lysholm 94.6), and radiological results were provided for seven. In the two newly reported cases, satisfactory functional results were obtained and MRI at 1-year follow-up revealed regular PT and ACL signal.

Conclusions

No consensus has been established for neither a diagnostic nor a therapeutic algorithm for simultaneous PT and ACL ruptures. Early combined arthroscopic treatment leads to good radiological results, accelerated recovery and patient satisfaction; further studies are required to confirm the role of arthroscopy and assess the superiority of a specific technique.

Level of evidence

Review of level IV and V studies and case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Baker BE (1980) O’Donoghue’s triad plus patellar tendon rupture. N Y State J Med 80:1436–1437

    CAS  PubMed  Google Scholar 

  2. Brunkhorst J, Johnson DL (2015) Multiligamentous knee injury concomitant with a patellar tendon rupture. Orthopedics 38:45–48

    Article  PubMed  Google Scholar 

  3. Casey MT, Tietjens BR (2001) Neglected ruptures of the patellar tendon. A case series of four patients. Am J Sports Med 29:457–460

    Article  PubMed  Google Scholar 

  4. Chiang AS, Shin SS, Jazrawi LM, Rose DJ (2005) Simultaneous ipsilateral ruptures of the anterior cruciate ligament and patellar tendon: a case report. Bull Hosp Jt Dis 62:134–136

    PubMed  Google Scholar 

  5. Chow FY, Wun Y-C, Chow Y-Y (2006) Simultaneous rupture of the patellar tendon and the anterior cruciate ligament: a case report and literature review. Knee Surg Sports Traumatol Arthrosc 14:1017–1020

    Article  PubMed  Google Scholar 

  6. Costa-Paz M, Muscolo DL, Makino A, Ayerza MA (2005) Simultaneous acute rupture of the patellar tendon and the anterior cruciate ligament. Arthroscopy 21:1143.e1–1143.e4

    Article  Google Scholar 

  7. Enad JG, Loomis LL (2001) Primary patellar tendon repair and early mobilization: results in an active-duty population. J South Orthop Assoc 10:17–23

    CAS  PubMed  Google Scholar 

  8. Futch LA, Garth WP, Folsom GJ, Ogard WK (2007) Acute rupture of the anterior cruciate ligament and patellar tendon in a collegiate athlete. Arthroscopy 23:112.e1–112.e4

    Article  Google Scholar 

  9. Gilmore JH, Clayton-Smith ZJ, Aguilar M, Pneumaticos SG, Giannoudis PV (2015) Reconstruction techniques and clinical results of patellar tendon ruptures: evidence today. Knee 22:148–155

    Article  PubMed  Google Scholar 

  10. Greis PE, Holmstrom MC, Lahav A (2005) Surgical treatment options for patella tendon rupture, part I: acute. Orthopedics 28:672–679

    PubMed  Google Scholar 

  11. Greis PE, Lahav A, Holmstrom MC (2005) Surgical treatment options for patella tendon rupture, part II: chronic. Orthopedics 28:765–769

    PubMed  Google Scholar 

  12. Gülabi D, Erdem M, Bulut G, Sağlam F (2014) Neglected patellar tendon rupture with anterior cruciate ligament rupture and medial collateral ligament partial rupture. Acta Orthop Traumatol Turc 48:231–235

    Article  PubMed  Google Scholar 

  13. Halinen J, Lindahl J, Hirvensalo E, Santavirta S (2006) Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med 34:1134–1140

    Article  PubMed  Google Scholar 

  14. Höher J, Offerhaus C (2014) Conservative versus operative treatment. In: Siebold R, Dejour D, Zaffagnini S (eds) Anterior cruciate ligament reconstruction. Springer, Berlin, Heidelberg, pp 77–84

    Chapter  Google Scholar 

  15. Kelly DW, Carter VS, Jobe FW, Kerlan RK (1984) Patellar and quadriceps tendon ruptures—jumper’s knee. Am J Sports Med 12:375–380

    Article  CAS  PubMed  Google Scholar 

  16. Kim DH, Lee GC, Park S (2014) Acute simultaneous ruptures of the anterior cruciate ligament and patellar tendon. Knee Surg Relat Res 26:56–60

    Article  PubMed  PubMed Central  Google Scholar 

  17. Koukoulias NE, Koumis P, Papadopoulos A, Kyparlis D, Papastergiou SG (2011) Acute, simultaneous tear of patellar tendon and ACL: possible mechanism of injury and rationality of the two-stage surgical treatment. BMJ Case Rep. doi:10.1136/bcr.05.2011.4178

    Google Scholar 

  18. Levakos Y, Sherman MF, Shelbourne KD, Trakru S, Bonamo JR (1996) Simultaneous rupture of the anterior cruciate ligament and the patellar tendon. Six case reports. Am J Sports Med 24:498–503

    Article  CAS  PubMed  Google Scholar 

  19. Magit D, Wolff A, Sutton K, Medvecky MJ (2007) Arthrofibrosis of the knee. J Am Acad Orthop Surg 15:682–694

    Article  PubMed  Google Scholar 

  20. Mariani PP, Cerullo G, Iannella G (2013) Simultaneous rupture of the patellar tendon and the anterior cruciate ligament: report of three cases. J Knee Surg 26(Suppl 1):S53–S57

    PubMed  Google Scholar 

  21. McKinney B, Cherney S, Penna J (2008) Intra-articular knee injuries in patients with knee extensor mechanism ruptures. Knee Surg Sports Traumatol Arthrosc 16:633–638

    Article  PubMed  Google Scholar 

  22. Mink JH, Levy T, Crues JV (1988) Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology 167:769–774

    Article  CAS  PubMed  Google Scholar 

  23. Miyamoto RG, Bosco JA, Sherman OH (2009) Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg 17:152–161

    Article  PubMed  Google Scholar 

  24. Nakamura N, Horibe S, Toritsuka Y, Mitsuoka T, Yoshikawa H, Shino K (2003) Acute grade III medial collateral ligament injury of the knee associated with anterior cruciate ligament tear. The usefulness of magnetic resonance imaging in determining a treatment regimen. Am J Sports Med 31:261–267

    Article  PubMed  Google Scholar 

  25. Nsouli AZ, Nsouli TA, Haidar R (1991) Late reconstruction of the patellar tendon: case report with a new method of repair. J Trauma 31:1319–1321

    Article  CAS  PubMed  Google Scholar 

  26. Rae PJ, Davies DR (1991) Simultaneous rupture of the ligamentum patellae, medial collateral, and anterior cruciate ligaments. A case report. Am J Sports Med 19:529–530

    Article  CAS  PubMed  Google Scholar 

  27. Ramseier LE, Werner CML, Heinzelmann M (2006) Quadriceps and patellar tendon rupture. Injury 37:516–519

    Article  CAS  PubMed  Google Scholar 

  28. Siwek CW, Rao JP (1981) Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am 63:93293–93297

    Article  Google Scholar 

  29. Stoehr A, Mayr H, Wondrasch B, Fink C (2014) Rehabilitation and return to sports. In: Siebold R, Dejour D, Zaffagnini S (eds) Anterior cruciate ligament reconstruction. Springer, Berlin, Heidelberg, pp 477–487

    Chapter  Google Scholar 

  30. Tsarouhas A, Iosifidis M, Kotzamitelos D, Traios S (2011) Combined rupture of the patellar tendon, anterior cruciate ligament and lateral. Hippokratia 15:178–180

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Wissman RD, Vonfischer N, Kempf K (2012) Acute concomitant anterior cruciate ligament and patellar tendon tears in a non-dislocated knee. J Clin Imaging Sci 2:1–3

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Davide Cucchi & Pietro Randelli

  2. U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy

    Davide Cucchi & Pietro Randelli

  3. Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy

    Alberto Aliprandi & Elisabetta Nocerino

  4. Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy

    Elisabetta Nocerino

Authors
  1. Davide Cucchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Aliprandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabetta Nocerino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pietro Randelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DC performed literature review, clinical evaluation of reported cases, original draft preparation; AA and EN contributed to radiological evaluation of reported cases, discussion, figures; PR was involved in surgical evaluation of reported cases and manuscript correction.

Corresponding author

Correspondence to Davide Cucchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest relevant to this study.

Funding

This study was not funded.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cucchi, D., Aliprandi, A., Nocerino, E. et al. Early combined arthroscopic treatment for simultaneous ruptures of the patellar tendon and the anterior cruciate ligament leads to good radiological results and patient satisfaction. Knee Surg Sports Traumatol Arthrosc 26, 1164–1173 (2018). https://doi.org/10.1007/s00167-017-4562-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4562-2

Keywords

Search

Navigation