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

Abstract

To evaluate the clinical and functional outcome following the reconstruction of chronic patellar tendon ruptures using the contralateral bone-tendon-bone (BTB) autograft. 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 3months 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. 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 16months (3-60months) 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±0.7cm (ns). No surgical complications were encountered. 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.