Abstract
Purpose
To evaluate the clinical and functional outcome following the reconstruction of chronic patellar tendon ruptures using the contralateral bone-tendon-bone (BTB) autograft.
Methods
The records of seven patients who underwent reconstruction of chronic patellar tendon rupture with contralateral patellar BTB were retrospectively reviewed. Chronic tears were defined as a minimum of 3 months from injury to initial clinical evaluation. Clinical assessments included range of motion of the knee, Tegner, Lysholm and International Knee Documentation Committee (IKDC) score and a radiographic analysis of patellar height (Caton–Deschamps index). Postoperative complications and quadriceps strength at last follow-up were reported.
Results
The mean age of the patients undergoing surgery was 33 (±10.5) years with a mean follow-up of 41.3 (±29.7) months. Reconstruction surgery was performed at an average of 16 months (3–60 months) after the injury. 86 % of the patients had a normal patella height with mean of patellar height of 1.5 (±0.2) in preoperative radiographs and of 1.2 (±0.07) on postoperative evaluation (p = 0.0136). The mean IKDC was 45.5 (±10.8) before surgery and 64.5 (±12.4) at the last follow-up (p = 0.0001), and Lysholm score was 45.4 (±11.3) and 79 (±11.8), respectively (p = 0.0001). The median Tegner activity scale preinjury was 6 (range 5–7), preoperatively was 1 (range 1–2) and 4 (range 2–5) postoperatively (p = 0.0001). All patients had quadriceps wasting with a difference in thigh girth between the injured side and healthy side of 3.6 ± 0.7 cm (ns). No surgical complications were encountered.
Conclusions
In this limited cohort, surgical reconstruction of chronic patellar tendon ruptures using contralateral bone-tendon-bone graft was a safe and viable option that improves clinical and functional outcomes compared to presurgical function. However, despite the restoration of a normal patellar height, function did not return to preinjury level.
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References
Bollen S, Seedhom BB (1991) A comparison of the Lysholm and Cincinnati knee scoring questionnaires. Am J Sport Med 19(2):189–190
Casey MT Jr, Tietjens BR (2001) Neglected ruptures of the patellar tendon A case series of four patients. Am J Sport Med 29(4):457–460
Chagar B, Boussouga M, Lazrak KH, Taobane H (2003) [Neglected spontaneous bilateral rupture of the patellar tendon: a case report]. French. Rev Chir Orthop Reparatrice Appar Mot 89(8):733–737
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(4):508–512
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-A(8):1354–1361
Dejour H, Denjean S, Neyret P (1992) [Treatment of old or recurrent ruptures of the patellar ligament by contralateral autograft]. French. Rev Chir Orthop Reparatrice Appar Mot 78(1):58–62
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26
Ecker ML, Lotke PA, Glazer RM (1979) Late reconstruction of the patellar tendon. J Bone Joint Surg Am 61(6):884–886
Fukuta S, Kuge A, Nakamura M (2003) Use of the Leeds-Keio prosthetic ligament for repair of patellar tendon rupture after total knee arthroplasty. Knee 10(2):127–130
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(3):148–155
Greis PE, Lahav A, Holmstrom MC (2005) Surgical treatment options for patella tendon rupture, part II: chronic. Orthopedics 28(8):765–769
Isiklar ZU, Varner KE, Lindsey RW, Bocell JR, Lintner DM (1996) Late reconstruction of patellar ligament ruptures using Ilizarov external fixation. Clin Orthop Relat Res 322:174–178
Jaureguito JW, Dubois CM, Smith SR, Gottlieb LJ, Finn HA (1997) Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am 79(6):866–873
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(12):1445–1448
Mittal R, Singh DP, Kapoor A (2011) Neglected patellar tendon rupture: preserve the fat pad. Orthopedics 34(2):134
Miyamoto W, Takao M, Matsushita T (2012) Reconstructive surgery using autologous bone-patellar tendon graft for insertional achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 9:1863–1867
Naim S, Gougoulias N, Griffiths D (2011) Patellar tendon reconstruction using LARS ligament: surgical technique and case report. Strateg Trauma Limb Reconstr 6(1):39–41
Rand JA, Morrey BF, Bryan RS (1989) Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res 244:233–238
Shabshin N, Schweitzer ME, Morrison WB, Parker L (2004) MRI criteria for patella alta and baja. Skelet Radiol 33(8):445–450
Shelbourne KD, Beck MB, Gray T (2015) Anterior cruciate ligament reconstruction with contralateral autogenous patellar tendon graft: evaluation of donor site strength and subjective results. J Bone Joint Surg Am 43(3):648–653
Shelbourne KD, Darmelio MP, Klootwyk TE (2001) Patellar tendon rupture repair using Dall-Miles cable. Am J Knee Surg 14(1):17–20
Shelbourne KD, Urch SE (2000) Primary anterior cruciate ligament reconstruction using the contralateral autogenous patellar tendon. Am J Sport Med 28(5):651–658
Shepard GJ, Christodoulou L, Hegab AI (1999) Neglected rupture of the patellar tendon. Arch Orthop Trauma Surg 119(3–4):241–242
Sundararajan SR, Srikanth KP, Rajasekaran S (2013) Neglected patellar tendon ruptures: a simple modified reconstruction using hamstrings tendon graft. Int Orthop 37(11):2159–2164
Takazawa Y, Ikeda H, Ishijima M, Kubota M, Saita Y, Kaneko H, Kobayashi Y, Sadatsuki R, Hada S, Kaneko K (2013) Reconstruction of a ruptured patellar tendon using ipsilateral semitendinosus and gracilis tendons with preserved distal insertions: two case reports. BMC Res Notes 6:361
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Tsitskaris K, Subramanian P, Crone D (2013) Neglected patellar tendon rupture. Reconstruction using semitendinosus-gracilis tendon grafts and FiberWire augmentation. JRSM Short Rep 4(8):2042533313490286
Williams S, Ireland J, El Zebdeh MY (1997) Late reconstruction of the patellar tendon: two case reports. Knee 4(2):113–115
Yang L, Guo L, Dai C, Han XS, Chen GX, Duan XJ, Dai G, Xie F (2007) Bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction: allograft versus autograft. Zhonghuawaikezazhi [Chinese Journal of Surgery] 45(2):82–85
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Temponi, E.F., Camelo, N., Tuteja, S. et al. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc 25, 2468–2473 (2017). https://doi.org/10.1007/s00167-015-3951-7
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DOI: https://doi.org/10.1007/s00167-015-3951-7