Skip to main content
SpringerLink
Log in

Patellarsehnenruptur 10 Jahre nach vorderem Kreuzbandersatz durch Patellarsehnen-Knochen-Transplantat

Late patellar tendon rupture 10 years after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft

  • Kasuistiken
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die autologe Transplantation des zentralen Drittels der Patellarsehne mit Patellarsehnen-Knochen-Transplantat (BTB) ist eine aktuell weit verbreitete Technik zur vorderen Kreuzbandrekonstruktion. Ein fast ebenso häufig verwendetes Verfahren ist die Transplantation der sog. Hamstringsehnen der Mm. semitendinosus und gracilis. In der Diskussion, welches Verfahren das zu favorisierende sei, werden neben Stabilitäts- und Funktionstests die Komplikationen beider Verfahren gegenüber gestellt. Hinsichtlich der Rekonstruktion durch einen Patellarsehnen-Knochenblock sind im Besonderen eine erhöhte Entnahmemorbidität in der frühen Rehabilitation und Spätschäden des Kniegelenkstreckapparats beschrieben. Dabei sind in der Zusammenschau komplette Patellarsehnenrupturen eher selten, und wenn, am häufigsten in der frühen postoperativen Phase zu finden. Wir beschreiben den Fall einer späten Patellarsehnenruptur eines 36-jährigen, gesunden Mannes im Rahmen eines Skiunfalls 10 Jahre nach vorderem Kreuzbandersatz mittels Patellarsehnen-Knochenblock-Transplantat und die nachfolgende Therapie.

Abstract

Autologous transplantation of the central third of the patella tendon with a bone-patellar tendon-bone (BTB) graft is one of the most commonly used techniques for anterior cruciate ligament (ACL) reconstruction. Frequently chosen alternative sources include semitendinosus and gracilis tendon autografts. The differences of opinion regarding graft sources mainly result from comparison of outcome and complications. Although higher donor site morbidity and postoperative extensor mechanism complications are postulated for bone-patellar tendon-bone grafts, patellar tendon ruptures following anterior cruciate ligament reconstruction are rarely reported in the literature. These predominantly occur during the early postoperative period. We present the case of a patellar tendon rupture in a healthy 36-year-old man, who suffered a skiing accident 10 years after uneventful ACL reconstruction with a BTB graft.

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

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Ahrberg A, Josten C (2007) Augmentation of patella fractures and patella tendon ruptures with the McLaughlin cerclage. Unfallchirurg 110:685–690

    Article  PubMed  CAS  Google Scholar 

  2. Amlang MH, Zwipp H (2006) Damage to large tendons: Achilles, patellar and quadriceps tendons. Chirurg 77:637–49, quiz

    Article  PubMed  CAS  Google Scholar 

  3. Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg [Br] 59:241–242

    Google Scholar 

  4. Bonamo JJ, Krinick RM, Sporn AA (1984) Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction. A report of two cases. J Bone Joint Surg [Am] 66:1294–1297

    Google Scholar 

  5. Bonatus TJ, Alexander AH (1991) Patellar fracture and avulsion of the patellar ligament complicating arthroscopic anterior cruciate ligament reconstruction. Orthop Rev 20:770–774

    PubMed  CAS  Google Scholar 

  6. Brandsson S, Faxen E, Eriksson BI et al (1998) Closing patellar tendon defects after anterior cruciate ligament reconstruction: absence of any benefit. Knee Surg Sports Traumatol Arthrosc 6:82–87

    Article  PubMed  CAS  Google Scholar 

  7. Breitfuss H, Frohlich R, Povacz P et al (1996) The tendon defect after anterior cruciate ligament reconstruction using the midthird patellar tendon – a problem for the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 3:194–198

    Article  PubMed  CAS  Google Scholar 

  8. Burks RT, Haut RC, Lancaster RL (1990) Biomechanical and histological observations of the dog patellar tendon after removal of its central one-third. Am J Sports Med 18:146–153

    Article  PubMed  CAS  Google Scholar 

  9. Busam ML, Provencher MT, Bach BR Jr (2008) Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. Am J Sports Med 36:379–394

    Article  PubMed  Google Scholar 

  10. Cabaud HE, Feagin JA, Rodkey WG (1980) Acute anterior cruciate ligament injury and augmented repair. Experimental studies. Am J Sports Med 8:395–401

    Article  PubMed  CAS  Google Scholar 

  11. Chouliaras V, Ristanis S, Moraiti C et al (2007) Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts: an in vivo study comparing tibial internal-external rotation. Am J Sports Med 35:189–196

    Article  PubMed  Google Scholar 

  12. DeLee JC, Craviotto DF (1991) Rupture of the quadriceps tendon after a central third patellar tendon anterior cruciate ligament reconstruction. Am J Sports Med 19:415–416

    Article  PubMed  CAS  Google Scholar 

  13. Ecker ML, Lotke PA, Glazer RM (1979) Late reconstruction of the patellar tendon. J Bone Joint Surg [Am] 61:884–886

    Google Scholar 

  14. Hardin GT, Bach BR Jr (1992) Distal rupture of the infrapatellar tendon after use of its central third for anterior cruciate ligament reconstruction. Am J Knee Surg 5:140–143

    Google Scholar 

  15. Jackson DW, Grood ES, Goldstein JD et al (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21:176–185

    Article  PubMed  CAS  Google Scholar 

  16. Johnson DL, Either DB, Vanarthos WJ (1996) Herniation of the patellar fat pad through the patellar tendon defect after autologous bone-patellar tendon-bone anterior cruciate ligament reconstruction. A case report. Am J Sports Med 24:201–204

    Article  PubMed  CAS  Google Scholar 

  17. Kamps BS, Linder LH, DeCamp CE, Haut RC (1994) The influence of immobilization versus exercise on scar formation in the rabbit patellar tendon after excision of the central third. Am J Sports Med 22:803–811

    Article  PubMed  CAS  Google Scholar 

  18. Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg [Am] 73:1507–1525

    Google Scholar 

  19. Kartus J, Magnusson L, Stener S et al (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7:2–8

    Article  PubMed  CAS  Google Scholar 

  20. Kessler MA, Behrend H, Henz S et al (2008) Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 5:442–448

    Article  Google Scholar 

  21. Kohn D, Sander-Beuermann A (1994) Donor-site morbidity after harvest of a bone-tendon-bone patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc 2:219–223

    Article  PubMed  CAS  Google Scholar 

  22. Langan P, Fontanetta AP (1987) Rupture of the patellar tendon after use of its central third. Orthop Rev 16:317–321

    PubMed  CAS  Google Scholar 

  23. Lee GH, McCulloch P, Cole BJ et al (2008) The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy 24:162–166

    PubMed  Google Scholar 

  24. Liden M, Ejerhed L, Sernert N et al (2007) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-year follow-up. Am J Sports Med 35:740–748

    Article  PubMed  Google Scholar 

  25. Lobenhoffer P, Thermann H (2000) Quadrizeps- und Patellarsehnenrupturen. Orthopäde 29:228–234

    PubMed  CAS  Google Scholar 

  26. Marumoto JM, Mitsunaga MM, Richardson AB et al (1996) Late patellar tendon ruptures after removal of the central third for anterior cruciate ligament reconstruction. A report of two cases. Am J Sports Med 24:698–701

    Article  PubMed  CAS  Google Scholar 

  27. McLaughlin HL, Francis KC (1956) Operative repair of injuries to the quadriceps extensor mechanism. Am J Surg 91:651–653

    Article  PubMed  CAS  Google Scholar 

  28. Mickelsen PL, Morgan SJ, Johnson WA, Ferrari JD (2001) Patellar tendon rupture 3 years after anterior cruciate ligament reconstruction with a central one third bone-patellar tendon-bone graft. Arthroscopy 17:648–652

    PubMed  CAS  Google Scholar 

  29. Miller MD, Nichols T, Butler CA (1999) Patella fracture and proximal patellar tendon rupture following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 15:640–643

    Article  PubMed  CAS  Google Scholar 

  30. Muller B, Rupp S, Kohn D, Seil R (2000) Donor site problems after anterior cruciate ligament reconstruction with the middle third of the patellar ligament. Unfallchirurg 103:662–667

    Article  PubMed  CAS  Google Scholar 

  31. Nikolaou VS, Efstathopoulos N, Wredmark T (2007) Hamstring tendons regeneration after ACL reconstruction: an overview. Knee Surg Sports Traumatol Arthrosc 15:153–160

    Article  PubMed  Google Scholar 

  32. Ouweleen KM, McElroy JJ (1995) A unique complication following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 11:225–228

    PubMed  CAS  Google Scholar 

  33. Pinczewski LA, Lyman J, Salmon LJ et al (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  34. Poolman RW, Abouali JA, Conter HJ, Bhandari M (2007) Overlapping systematic reviews of anterior cruciate ligament reconstruction comparing hamstring autograft with bone-patellar tendon-bone autograft: why are they different? J Bone Joint Surg [Am] 89:1542–1552

    Google Scholar 

  35. Rose PS, Frassica FJ (2001) Atraumatic bilateral patellar tendon rupture. A case report and review of the literature. J Bone Joint Surg [Am] 83-A:1382–1386

    Google Scholar 

  36. Rubinstein RA Jr, Shelbourne KD, VanMeter CD et al (1994) Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med 22:324–327

    Article  PubMed  Google Scholar 

  37. Sajovic M, Vengust V, Komadina R et al (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 34:1933–1940

    Article  PubMed  Google Scholar 

  38. Sherman OH, Banffy MB (2004) Anterior cruciate ligament reconstruction: which graft is best? Arthroscopy 20:974–980

    PubMed  Google Scholar 

  39. Sousa A, Matos R, Veludo V et al (2002) Patellar tendon avulsion after reconstruction of the anterior cruciate ligament. Int Orthop 26:129–130

    Article  PubMed  CAS  Google Scholar 

  40. Spindler KP, Kuhn JE, Freedman KB et al (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring. Does it really matter? A systematic review. Am J Sports Med 32:1986–1995

    Article  PubMed  Google Scholar 

  41. Svensson M, Kartus J, Christensen LR et al (2005) A long-term serial histological evaluation of the patellar tendon in humans after harvesting its central third. Knee Surg Sports Traumatol Arthrosc 13:398–404

    Article  PubMed  Google Scholar 

  42. Tsuda E, Okamura Y, Ishibashi Y et al (2001) Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 29:450–456

    PubMed  CAS  Google Scholar 

  43. Vardi G (2004) Sciatic nerve injury following hamstring harvest. Knee 11:37–39

    Article  PubMed  Google Scholar 

  44. Weber K, Schmidgen A, Wentzensen A (2000) Patellarsehnenruptur nach vorderer Kreuzbandrekonstruktion mit autologem Patellarsehnen-Knochen-Transplantat. Eine Kasuistik. Unfallchirurg 103:1124–1127

    Article  PubMed  CAS  Google Scholar 

  45. Zaffagnini S, Marcacci M, Lo PM et al (2006) Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 14:1060–1069

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung Kniechirurgie, Chirurgische Klinik und Poliklinik, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland

    F. Haasters, B. Ockert, W. Mutschler &  M.A. Kessler

Authors
  1. F. Haasters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Ockert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Mutschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M.A. Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.A. Kessler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haasters, F., Ockert, B., Mutschler, W. et al. Patellarsehnenruptur 10 Jahre nach vorderem Kreuzbandersatz durch Patellarsehnen-Knochen-Transplantat. Unfallchirurg 112, 728–733 (2009). https://doi.org/10.1007/s00113-008-1555-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-008-1555-0

Schlüsselwörter

Keywords

Search

Navigation