Skip to main content
Log in

Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft

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

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 (CatonDeschamps 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.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bollen S, Seedhom BB (1991) A comparison of the Lysholm and Cincinnati knee scoring questionnaires. Am J Sport Med 19(2):189–190

    Article  CAS  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    CAS  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    CAS  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Ecker ML, Lotke PA, Glazer RM (1979) Late reconstruction of the patellar tendon. J Bone Joint Surg Am 61(6):884–886

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Greis PE, Lahav A, Holmstrom MC (2005) Surgical treatment options for patella tendon rupture, part II: chronic. Orthopedics 28(8):765–769

    PubMed  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  CAS  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Mittal R, Singh DP, Kapoor A (2011) Neglected patellar tendon rupture: preserve the fat pad. Orthopedics 34(2):134

    PubMed  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. Rand JA, Morrey BF, Bryan RS (1989) Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res 244:233–238

    Google Scholar 

  19. Shabshin N, Schweitzer ME, Morrison WB, Parker L (2004) MRI criteria for patella alta and baja. Skelet Radiol 33(8):445–450

    Article  Google Scholar 

  20. 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

    Google Scholar 

  21. Shelbourne KD, Darmelio MP, Klootwyk TE (2001) Patellar tendon rupture repair using Dall-Miles cable. Am J Knee Surg 14(1):17–20

    CAS  PubMed  Google Scholar 

  22. Shelbourne KD, Urch SE (2000) Primary anterior cruciate ligament reconstruction using the contralateral autogenous patellar tendon. Am J Sport Med 28(5):651–658

    Article  CAS  Google Scholar 

  23. Shepard GJ, Christodoulou L, Hegab AI (1999) Neglected rupture of the patellar tendon. Arch Orthop Trauma Surg 119(3–4):241–242

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. 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

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  27. 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

    Article  PubMed  PubMed Central  Google Scholar 

  28. Williams S, Ireland J, El Zebdeh MY (1997) Late reconstruction of the patellar tendon: two case reports. Knee 4(2):113–115

    Article  Google Scholar 

  29. 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

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eduardo Frois Temponi.

Ethics declarations

Conflict of interest

None.

Additional information

None of the following authors or the departments with which they are affiliated have received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 54313 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3951-7

Keywords

Navigation