Management of Chronic Patellar Tendon Rupture Left Knee Joint with Primary Repair Using Fiber Wire and Endo Button As A Cost-Effective and Simple Anatomical Reconstruction Without Grafts: A Case Report

Abstract

Patellar tendon ruptures mostly occur in persons under 40 years of age, typically during sports activities. Neglected ruptures of the patellar tendon, defined as ruptures presenting after six weeks, are often difficult to repair, and different techniques have been described for reconstruction of this uncommon problem including the use of auto-grafts, allografts, and synthetic materials. We hereby describe a cost-effective and simple anatomical reconstruction without the requirement for grafts for chronic patellar tendon injuries. This is a retrospective study of a 29-year-old man who came to the orthopaedic clinic with the chief complaint of pain in the left knee. Pain has been felt since 2 years ago after the patient falls when were playing football. After the incident, the patient was taken to alternative therapy, but still felt the pain and difficulty moving the left knee. From the physical examination, the patient presented elevation of left patella height, localized tenderness, palpable gap below the inferior pole of the patella, and limited range of movement on the left knee. There was also a straight leg raise provocative test positive. The x-ray results were obtained patella alta with Insall-Salvatti Index was 1.6. An MRI examination was also performed, showing patella contusion and marrow edema, suspicious of soft tissue rupture, with intact ACL/PCL. The patient was diagnosed with chronic patellar tendon rupture of the left knee. At the time of surgery, it was found that the patellar tendon ruptured with remnants still on the distal part, and the cartilage was still in good condition. The next step is to perform a primary repair of the patellar tendon using fiber wire and endo button at the tibial part. Postoperative rehabilitation was carried out by starting limited ROM exercise of the left knee on day 4. Six weeks after surgery, there was an improvement in left knee ROM and improvement in walking ability. In this case, primary repair of patellar tendon using fiber wire and endo button provides good results and can be used as a costeffective and simple anatomical reconstruction without the requirement for grafts.