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Patellar tendon rupture after total knee arthroplasty: semitendinosus tendon graft augmentation with direct repair

  • Original Article
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European Orthopaedics and Traumatology

Abstract

Introduction

Rupture of the patellar tendon after total knee arthroplasty is an infrequent but serious complication. Several methods for treating this catastrophic complication have been described. The purpose of this article was to evaluate the results of semitendinosus graft augmentation with direct repair in the treatment of patellar tendon rupture after total knee arthroplasty.

Material and methods

From 2012 to 2014, six patients who underwent cemented total knee arthroplasty without patellar resurfacing presented with patellar tendon rupture after operation. Patellar tendon repair and augmentation with autogenous ipsilateral semitendinosus graft was scheduled with preparation of stocks of primary and revision prosthesis.

Results

All knees required revision either all components or one of the components. Postoperative radiograph confirmed that normal patellar height was with good alignment of all prosthesis components. Patients were followed up for average 1.5 years. No intra- or postoperative complications were recorded. Functionally, scores at final follow-up were excellent in two patients and good in four patients according to Knee Society clinical rating scores. The average active range of motion is from 10 to 135°. All patients could return to their daily activities without pain.

Conclusion

The right alignment and rotation of the knee prosthesis, together with good surgical technique in a primary operation, are the most important factors to avoid the catastrophic complication of patellar tendon rupture during or after the total knee arthroplasty. However, if patellar tendon rupture does occur, the use of our operative technique and rehabilitation program can bring good functional results.

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References

  1. Rand JA, Morrey BF, Bryan RS (1989) Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res : 233–238

  2. Wilson FC (1980) Results of knee replacement with the Walldius and geometric prostheses: a comparative study. J Bone Joint Surg Am 62:497–503

    CAS  PubMed  Google Scholar 

  3. Hsu RW (2006) The management of the patella in total knee arthroplasty. Chang Gung Med J 29:448–457

    PubMed  Google Scholar 

  4. Järvelä T, Halonen P, Järvelä K, Moilanen T (2005) Reconstruction of ruptured patellar tendon after total knee arthroplasty: a case report and a description of an alternative fixation method. Knee 12:139–143

    Article  PubMed  Google Scholar 

  5. Cadambi A, Engh GA (1992) Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty: a report of seven cases. J Bone Joint Surg Am 74:974–979

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  7. Crossett LS, Sinha RK, Sechriest VF, Rubash HE (2002) Reconstruction of a ruptured patellar tendon with Achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am 84-84A:1354–1361

    Google Scholar 

  8. Zanotti RM, Freiberg AA, Matthews LS (1995) Use of patellar allograft to reconstruct a patellar tendon-deficient knee after total joint arthroplasty. J Arthroplasty 10:271–274

    Article  CAS  PubMed  Google Scholar 

  9. Browne JA, Hanssen AD (2011) Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J Bone Joint Surg Am 93:1137–1143

    Article  PubMed  Google Scholar 

  10. Milankov MZ, Miljkovic N, Stankovic M (2007) Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: a case report. Knee Surg Sports Traumatol Arthrosc 15:1445–1448

    Article  PubMed  Google Scholar 

  11. Kim JR, Park H, Roh SG, Shin SJ (2010) Concurrent bilateral patellar tendon rupture in a preadolescent athlete: a case report and review of the literature. J Pediatr Orthop B 19:511–514

    Article  PubMed  Google Scholar 

  12. Labib SA, Wilczynski MC, Sweitzer BA (2010) Two-layer repair of a chronique patellar tendon rupture: a novel technique and literature review. Am J Orthop (Belle Mead NJ) 39:277–282

    Google Scholar 

  13. Kelikian H, Riashi E, Gleason J (1957) Restoration of quadriceps function in neglected tear of the patellar tendon. Surg Gynaecol Obstet 104:200–204

    CAS  Google Scholar 

  14. Larson RV, Simonian PT (1995) Semitendinosus augmentation of acute patellar tendon repair with immediate mobilization. Am J Sports Med 23:82–86

    Article  CAS  PubMed  Google Scholar 

  15. Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557

    CAS  PubMed  Google Scholar 

  16. Van der Bracht H, Verdonk R, Stuyts B (2009) Augmentation of a patellar tendon repair with an autologous graft. Acta Orthop Belg 75:417–419

    PubMed  Google Scholar 

  17. Chen B, Li R, Zhang S (2012) Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. Knee 19:508–512

    Article  PubMed  Google Scholar 

  18. Kim SJ, Kim HK, Lee YT (1997) Arthroscopic anterior cruciate ligament reconstruction using autogenous hamstring tendon graft without detachment of the tibial insertion. Arthroscopy 13:656–660

    Article  CAS  PubMed  Google Scholar 

  19. Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H (2001) Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone–patellar tendon–bone graft in anterior cruciate ligament reconstruction. Arthroscopy 17:461–476

    Article  CAS  PubMed  Google Scholar 

  20. Ohkoshi Y, Inoue C, Yamane S, Hashimoto T, Ishida R (1998) Changes in muscle strength properties caused by harvesting of autogenous semitendinosus tendon for reconstruction of contralateral anterior cruciate ligament. Arthroscopy 14:580–584

    Article  CAS  PubMed  Google Scholar 

  21. Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602

    Article  PubMed  Google Scholar 

  22. Kuechle DK, Stuart MJ (1994) Isolated rupture of the patellar tendon in athletes. Am J Sports Med 22:692–695

    Article  CAS  PubMed  Google Scholar 

  23. Ortiguera CJ, Berry DJ (2002) Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am 84:532–540

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Ain Shams University, 13 B Kornish el Nile, Agha Khan, Cairo, 0020, Egypt

    Haytham Abdelazim & Ramy Ahmed Diab

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  1. Haytham Abdelazim
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  2. Ramy Ahmed Diab
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Correspondence to Ramy Ahmed Diab.

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Abdelazim, H., Diab, R.A. Patellar tendon rupture after total knee arthroplasty: semitendinosus tendon graft augmentation with direct repair. Eur Orthop Traumatol 6, 267–272 (2015). https://doi.org/10.1007/s12570-015-0292-4

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  • DOI: https://doi.org/10.1007/s12570-015-0292-4

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