Patellar Tendon Reconstruction Research Articles

Revision Patellar Tendon Reconstruction Using Hamstring Tendon Autograft

Background: Patellar tendon ruptures presenting in a chronic setting are rare events that impose technical surgical challenges due to proximal retraction of the patella, quadriceps muscle atrophy and contracture, and peripatellar adhesions. Various reconstruction techniques have been described using different grafts and fixation methods; however, there is a paucity of reported outcomes and there is no consensus on standard of care. Indications: The patient is a 36-year-old man who presented with a failed patellar tendon reconstruction 14 months after his initial surgery (performed 1 year after the initial injury) with functional weakness and loss of extension. The patient was indicated for a revision patellar tendon reconstruction due to persistent functional limitations. Technique Description: The revision patellar tendon reconstruction was performed with gracilis and semitendinosus tendon autografts harvested from the ipsilateral limb. Hardware was removed from the initial graft tunnels in the tibial tubercle and patella. Patellar height was estimated using fluoroscopic measurement of the contralateral patellar tendon length. The graft is first passed through the patellar tunnel, and the individual limbs of the graft are then both placed through the tibial tubercle tunnel. A sternal wire in a figure-of-eight configuration was used to progressively distalize the patella to match the native patellar height, and the graft was then tensioned and secured together. Results: The patient regained full range of motion at 2-year follow-up and was able to return to work and activities without functional limitations. Recent case series also using ipsilateral hamstring tendon autograft for chronic patellar tendon reconstruction report improved patient outcome scores, normal Insall-Salvati index, improved quadriceps strength, and high levels of patient satisfaction. Discussion/Conclusion: Chronic patellar tendon ruptures are technically challenging to treat, especially in the context of revision of a failed reconstruction. The technique presented in this video may aid orthopaedic surgeons in treating this rare but debilitating injury. Given the lack of high-quality evidence, future studies are needed to explore graft choices, graft fixation techniques, and postoperative protocols. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Outcomes and Complications Following Chronic Patellar Tendon Repair: A Systematic Review.

The purpose of this systematic review is to report outcomes and complications following the reconstruction of chronic patellar tendon ruptures. Four databases (Cochrane Database of Systematic Reviews, PubMed, Embase, MEDLINE) were searched from inception to July 2021. Inclusion criteria included articles that (1) analyzed outcomes and complications following chronic patellar tendon reconstruction (>4 weeks from injury to repair), (2) were written in English, (3) greater than five patients, and (4) a minimum 2-year follow-up. Exclusion criteria included (1) non-original research and (2) patellar tendon repair/reconstruction with prior total knee arthroplasty. Data on outcome metrics and complications were extracted from the included studies and reported in a qualitative manner. Nine studies (number of patients = 96) were included after screening. Seven studies analyzed autograft reconstruction, and three of those seven studies analyzed reconstructions with additional augmentation. The remaining two studies evaluated reconstruction utilizing a bone-tendon-bone (BTB) allograft. Four of the autograft studies (n=40 patients) showed a range of post-operative mean Lysholm scores of 74-94. Additionally, four studies reported a post-operative extensor lag of 0-3°. Post-operative protocol for autograft studies included delayed motion and was either contained to a bivalved cast or a hinged knee brace for six weeks. The two allograft studies reported a range of mean Lysholm scores from 62 to 67, and each immobilized the leg in full extension until six weeks. While chronic patellar tendon ruptures are a rare injury of the extensor mechanism, there are viable options for reconstruction. Overall, chronic patellar tendon ruptures reconstructed with both autograft and allograft will provide fair to good outcomes with low complication rates. Following surgery, immobilization for at least six weeks should be emphasized to protect the graft and optimize patient outcomes.

Delta technique reconstruction of a failed patellar tendon repair: a case report

Patellar tendon tears are rare debilitating injuries that deeply affect patients’ ability to ambulate. Prompt repair is recommended for more optimal outcomes. Chronic tears are more diffcult to treat. There is no standard of care procedure for this matter and multiple techniques have been described. In this article, we present a case of chronic recurrent patellar tendon tear that has failed surgery twice. The technique performed is a V-Y quadriceps-plasty along with a patellar tendon reconstruction using tibialis anterior allograft in a triangular fashion around the tibial tubercle or as we call a Delta repair of the patellar tendon. A dermal allograft was used to drape our construct providing a biological scaffold. This technique is not previously described as of the time of publication of this paper.

Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete: An uncommon injury

Introduction: Patellar tendon rupture is a rare entity, accounting for 3% of all knee extension system injuries. In some cases, the tear is accompanied with avulsed tibial tubercle. Such concurrent fracture is extremely rare, and only a few previously cases have been described in the literature. We reported a 13-year-old male with combined avulsion fracture of the tibial tubercule and patellar tendon rupture. Case Report: A 13-year-old male junior basketball athlete presenting with left knee pain since 2 days before admission. The patient had previously fell to the ground with his left knee hitting the ground while playing basketball. Physical examination demonstrated swollen left knee. Radiographic examination suggested tibial tubercle avulsion, and magnetic resonance imaging demonstrated partial rupture of distal patellar tendon. The patient then underwent open reduction and internal fixation using single cannulated screw for the avulsed tibial tubercle, and patellar tendon reconstruction using suture anchor with ultra high molecular weight polyethylene fibers. Postoperatively, the patient was placed in a locked straight leg brace. One week after surgery, the patient began range of motion exercises and progression of weight bearing with physical therapy. At 4 months of follow-up, the patient can already weightbear, and he had regained active knee range of motion. Discussion: Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete is an extremely rare case. As such, there is no guideline regarding the best treatment. In this report, we chose open surgery for anatomical reduction of the tuberosity fragment because we consider the growth plate and direct visualization of the patellar tendon. Rigorous physical therapy is of utmost importance in this patient for return to sport, as he is a young athlete. Conclusions: Open reduction and internal fixation using single cannulated screw, and patellar tendon reconstruction suture anchor might be a treatment of choice for those with combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young patients.

Neglected Patellar Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation: A Case Report

Introduction: Inferior pole patellar fractures occur in relatively young patients after eccentric contraction of the quadriceps or direct trauma. Early diagnosis and adequate treatment lead to excellent outcomes and prevent tendon retraction and scarring. The aim of surgical treatment is to restore of extensor mechanism rather than anatomical articular reduction. We propose a cerclage wire technique using ipsilateral hamstring augmentation for the patellar tracking restoration. Case Description: A forty nine-year-old female, presented to our sport clinic with chief complaint of pain in the left knee and difficulty in walking and standing in long period of time following a direct trauma falling from the stairs to the knee one year back. Clinical examination revealed gap in the left knee cap and the patient could not able to straighten the knee actively. Plain radiographs of knee were taken in anteroposterior and lateral views show fracture of the inferior pole of the left patella. Magnetic resonance imaging (MRI) of the knee confirmed inferior pole patellar fracture with the proximal migration of patella with no other intraarticular injuries with partial tear of left patellar tendon. Patellar tendon reconstruction was planned using ipsilateral semitendinosus (ST) and Gracillis (G) autograft and ORIF cerclage wire augmentation. Follow-up was performed after one month post-operation. Patient was able to straighten the left knee and fully weight bearing mobilized without any pain. Range of motion was 0/100 compared to the contralateral knee. Muscle atrophy was not found. Xray was performed and shows callus formation with stable fixation. Conclusion: Neglected patellar fracture is a rare occurrence, the treatment of which is a difficult challenge for orthopaedic surgeons. Therefore, the goal of surgical treatment of inferior pole fractures is restoration of extensor mechanism rather than anatomical articular reduction. In inferior pole fracture of the patella, comminution in fractured distal fragment is common and secure fixation to allow early motion is difficult to achieve. The advantage of the described technique is the possibility of immediate weightbearing and early mobilization. A parallel could be drawn with the biological augment for patellar tendon repair, in which semitendinosus augmentation allows immediate postoperative mobilization with excellent functional results. This allows patients with early functional exercise and has a positive significance for the smooth recovery of the articular surface of the patella and recovery of knee extensor device function. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique.

Neglected Patellar Tendon Rupture Augmentation Using Fibertape Augmentation: A Case Report

Introduction: Rupture of the patellar tendon is an uncommon problem caused by athletic activities. Delayed treatment would result in suboptimal outcomes such as quadriceps contracture, residual quadriceps weakness, and loss of knee flexion. Case presentation: 18 years old female patient with a seven-month-old injury twisting her knee comes with pain and instability and positive anterior drawer test and Lachman test. The radiology findings showed total rupture of the anterior cruciate ligament (ACL) and partial tear of the patellar tendon on the MRI right knee. We perform a direct end-to-end approximation of the patellar tendon with augmentation through the transosseous site in the patella proximally and tibial tubercle distally without using a graft with a good outcome. Discussion: This is the first reported case where a patellar tendon reconstruction is done without implants, synthetic augmentation or graft. Based on this outcome, the use of this technique could be promising for patellar tendon augmentation without graft. This might be an alternative to the less expensive method of repairing a chronic patellar tendon rupture. Conclusion: The use of fibertape augmentation provides a practical solution for treating a neglected patellar tendon rupture with concurrent ligament injury needing graft repair. We believe that this technique is easily reproducible and warrants further investigation.

Satisfactory outcomes of patellar tendon reconstruction using achilles’ tendon allograft with bone block after infected total knee arthroplasty

PurposeExtensor mechanism disruption is an uncommon and devastating complication after total knee arthroplasty. It negatively affects patients’ quality of life and leads to significant functional limitations and the inability to stand and walk. The purpose of the present study was to evaluate the outcomes of the extensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty. It was hypothesized that it is a safe procedure and that patients will present good clinical and functional results.MethodsTen patients treated for infra-patellar extensor mechanism disruption after infected total knee arthroplasty were prospectively followed for two years. The mean age of patients was 70.8 (range 55–85), with a median BMI of 28.72 ± 2.2 kg/m2. All patients underwent reconstruction using a fresh frozen Achilles tendon allograft. Preoperative and postoperative evaluation included knee-related clinical and functional assessment based on objective and subjective scores, including the knee flexion, the extension lag, the Knee Society Score (KSS) clinical and functional, and the visual analog scale (VAS) for pain at 12 and 24 months. Radiological evaluation was also performed using the Caton-Deschamps index. Reported complications were also recorded.ResultsClinical and functional outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as follows: Knee flexion was improved from 66° ± 4.8 to 99.7° ± 3.9, and the extension lag was decreased from 28.3° ± 4.4 to 9° ± 2.7. The mean KSS clinical and functional were also improved from 22.6 ± 7.9 to 73.4 ± 3.9 and from 10 ± 13.8 to 55 ± 13.8, respectively. The VAS for pain was decreased from 8.1 ± 1.2 to 1.9 ± 1.2. The Caton-Deschamps index demonstrated a tendency to patella Alta. Two treatment failures were recorded, one patellar dislocation and one re-rupture revised to arthrodesis.ConclusionsExtensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty is an efficient and safe procedure for infra-patellar disruption. The present study’s findings demonstrate that most of the patients (80%) presented significant clinical and functional improvement at two-year follow-up.

Surgical Treatment of Iatrogenic Patella Baja.

Patella baja is characterized by a loss of patellar height and can develop as either an acute or chronic complication following a knee injury or surgical procedure. The purpose of this review is to describe the diagnosis and management of patella baja and highlight the senior author's surgical technique. The pathogenesis of patella baja involves a complex interaction between quadriceps dysfunction, immobilization, and inflammation leading to infrapatellar scarring and adhesions. It is associated with fractures about the knee and can result as a complication of surgical procedures such as anterior cruciate ligament (ACL) reconstruction, particularly bone-patellar tedon-bone autografts, high tibial osteotomies (HTOs), tibial tubercle osteotomies (TTOs), and total knee arthroplasties (TKAs). Patients with patella baja can have limited knee range of motion, anterior knee pain, significant weakness with active knee extension, and an extensor lag. Surgical intervention is indicated in cases of symptomatic patella baja. Treatment strategies include tibial tubercle proximalization, patellar tendon lengthening, and patellar tendon reconstruction. Allografts and autografts can be utilized to augment tendon lengthening or reconstructive procedures. Various small case series have reported favorable outcomes for these procedures. The treatment of patella baja is challenging and little consensus exists on optimal management, as much of the literature is limited to small case series. The preferred surgical technique of the senior author involves an end-to-end patellar tendon lengthening with hamstring autograft augmentation.

Effect of Lateral Extra-articular Tenodesis on the Rate of Revision Anterior Cruciate Ligament Reconstruction in Elite Athletes

Background: There is growing evidence that anterolateral procedures can reduce the risk of rerupture in high-risk recreational athletes undergoing primary anterior cruciate ligament (ACL) reconstruction (ACLR). However, this effectiveness has never been evaluated in elite athletes. Purpose: The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis (LET) in reducing revision rates in primary ACLR in elite athletes. Additionally, this study evaluated whether LET had a greater effect when combined with ACLR utilizing a hamstring or patellar tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive cohort of elite athletes with an isolated ACL tear undergoing autograft patellar or hamstring tendon reconstruction with or without Lemaire LET were analyzed between 2005 and 2018. A minimum 2-year follow-up was required. The association between the use of LET and ACL graft failure as defined by revision ACLR was evaluated with univariate and multivariate logistic regression models. Results: A total of 455 elite athletes (83% men and overall age 22.5 ± 4.7 years) underwent primary ACLR with (n = 117) or without (n = 338) a LET procedure. Overall, 36 athletes (7.9%) experienced ACL graft failure, including 32 (9.5%) reconstructions without a LET and 4 (3.4%) with a LET. Utilization of LET during primary ACLR reduced the risk of graft failure by 2.8 times, with 16.5 athletes needing LET to prevent a single ACL graft failure. Multivariate models showed that LET significantly reduced the risk of graft rupture (relative risk = 0.325; P = .029) as compared with ACLR alone after controlling for sex and age at ACLR. Including graft type in the model did not significantly change the risk profile, and although a patellar tendon graft had a slightly lower risk of failure, this was not statistically significant (P = .466). Conclusion: The addition of LET reduced the risk of undergoing revision by 2.8 times in elite athletes undergoing primary ACLR. This risk reduction did not differ significantly between the patellar tendon and hamstring tendon autografts. With these results, status as an elite athlete should be included in the indications for a LET, as they are at increased risk for ACL graft failure.

Effect of an Endoprosthetic Reconstruction Tube and Medial Gastrocnemius Flap on Extensor Mechanism Function After Oncologic Prosthesis Reconstruction of the Proximal Tibia

BackgroundExtensor mechanism reconstruction after the proximal tibial resection and implantation of a megaprosthesis is challenging. In this study, we evaluated the effectiveness of the Trevira tube and medial gastrocnemius flap in restoring extensor mechanism following the resection of proximal tibial tumor and implantation of megaprosthesis. MethodsForty patients who underwent endoprosthetic implantation following the resection of proximal tibial tumor and patellar tendon reconstruction with the Trevira tube and medial gastrocnemius flap were included. The outcome measures were knee range of motion, extensor mechanism function, patellar position, and limb function subjectively evaluated through Toronto Extremity Salvage Score and objectively through Musculoskeletal Tumor Society score. The mean follow-up of the patients was 6.1 years. ResultsThe patellar position was normal in 28 (70%) patients, patella baja in 3 (7.5%) patients, and patella alta in 9 (22.5%) patients. The mean active knee range of motion was 98.9 ± 17° (range: 85°-125°). Extension lag was present in 7 (17.5%) patients (range: 5°-20°). The mean Toronto Extremity Salvage Score of patients was 92.1 ± 6.9% (range: 85-100). The mean Musculoskeletal Tumor Society score of the patients was 87.7 ± 13 (range: 73.3-100). Postoperative complications included aseptic wound dehiscence (2 patients), aseptic loosening of the tibial component (1 patient), periprosthetic fracture in the femur (2 patients), and wound infection (1 patient). ConclusionTrevira tube combined with gastrocnemius flap augmentation is a suitable procedure for restoring extensor mechanism after proximal tibial resection and megaprosthesis implantation.

Complication after the reconstruction of the old patellar tendon rupture

Introduction. Chronic patellar tendon rupture (PTR) occurs rarely; its frequency and prevalence are unknown. There are very little data on the late patellar tendon reconstruction in rheumatoid arthritis and its complications. Case report. We presented a surgical repair of a PTR with early postoperative rupture of the contralateral patellar tendon for a 21-year-old woman with a past medical history of juvenile rheumatoid arthritis (treated with corticosteroids) who sustained initial injury 11 months prior to the presentation. The contralateral side was used for autograft harvesting. We used bone-tendon-bone (BTB) autograft and allografts followed by double-wire loop reinforcement and immediate postoperative mobilization. The patient was followed for 2 years, and the function of both knees was re-stored completely, with a full active range of motion. In this case, reconstruction of an 11-month-old chronic PTR (with complete resorption of the tendon and completely separated infrapatellar pads, complicated by the contralateral PTR) with BTB autograft and allografts and double wire loop reinforcement gave an excellent functional result. Two years after the surgical treatment, the extensor function of both knees was completely restored with a full range of movements. The patient reported satisfying outcomes and was able to return to all pre-injury activities without the assistance of orthopedic devices. Conclusion. This case report highlights the importance of the early diagnosis and describes operative techniques used in chronic PTR repair and treatments of the early postoperative complications such as rupture of the contralateral tendon.

Staged patellar tendon reconstruction using doubled bone-patellar tendon-bone allograft for infected patellar tendon rupture: a rare case report of three years follow-up

BackgroundPatellar tendon rupture is a relatively rare injury that usually requires surgical treatment. The optimal therapeutic strategy is still controversial, especially when either concomitant patellar tendon infection or soft tissue infection surrounds the patellar tendon. Until recently, most reported reconstruction methods are extensive and difficult to apply because of the poor condition of the soft tissue surrounding the patellar tendon.Case presentationA 19-year-old male patient presented to our clinic three weeks following a motorcycle accident. There was a 5 x 4 cm sized skin defect with soft tissue infection below the inferior pole of patella. We performed a staged patellar tendon reconstruction using a doubled bone-patellar tendon-bone allograft (BPTB) to the infected patellar tendon rupture, following local random fasciocutaneous flap and split-thickness skin graft. Three months following surgery, the patient was able to perform an active knee motion with no extension lag and excellent clinical functional result.Discussion and conclusionsOur technique introduced in this specific case is a relatively simple method to reconstruct chronic patellar tendon defects with limited incision exposing only the patellar tendon areas. We expect it can be less invasively performed on patients who have a soft tissue problem and cannot have extensive surgery.

Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects

To investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects. The clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed. The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts, in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella, and 1 bone tunnel was created beneath the tibial tuberosity. There were 8 males and 3 females with an average age of 30.1 years (range, 10-61 years). The average interval from the primary injury to the operation was 9.5 months (range, 2-36 months). According to Yousef classification, there were 7 cases of type A2, 3 cases of type B2, and 1 case of type C2. The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm (range, 2.7-7.1 cm). Subjective function scores [including International Knee Documentation Committee (IKDC) subjective score, Tegner activity level, and Lysholm score] were evaluated before operation and at last follow-up. The loss of knee extension, Caton index, and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured. All patients were followed up 24-66 months (mean, 34.2 months). All incisions were primary healing, and there were no complications such as wound infection, venous thrombosis of the lower extremities, stiffness of the knee joint, graft failure, neurovascular injury, etc. No second revision surgery was performed during the follow-up. At last follow-up, the subjective function scores (IKDC subjective score, Tegner activity level, Lysholm score), loss of knee extension, thigh circumference difference, and Caton index were significantly improved when compared with those before operation ( P<0.05). Two patients still had patella alta, with Caton indexes of 1.29 and 1.32, respectively. In the treatment of chronic patellar tendon ruptures and defects, the modified patellar tendon reconstruction using hamstring autograft can significantly improve the postoperative knee function, restore the normal range of knee extension, enhance the extensor and correct the patella alta.

Results of surgical treatment of the patellar tendon rupture

Introduction. The aim of the study was to report surgical treatment results of complete patellar tendon ruptures reconstructed by different surgical procedures. Material and Methods. This study included 35 patients, 26 males and 9 females, with an average age of 39 (range, 16 - 66) years. Seventeen patients had the risk factors (48.6%), including 11 with prior surgeries of the same knee: 7 reconstructions of the anterior cruciate ligament, 3 total knee replacement surgeries, and one intramedullary nailing. In 27 patients (77.1%), the surgery was performed during the first seven days after the injury. The following procedures were applied: patellar tendon repair with suture anchors in 5 cases; 13 transpatellar suturing through transpatellar tunnels; additional strengthening with wires and screws was performed in 7 patients; 7 reconstructions with bone-tendon-bone allograft taken from the bone bank, and in 3 patients contralateral bonetendon-bone autografts were used. Results and Discussion. The average Lysholm score was 86.1 (range, 27 - 100). Excellent results were found in 19 cases (54.2%), satisfactory in 10 (28.6%), and unsatisfactory in 6 patients (17.1%) who had chronic diseases and total knee replacement. The patients with timely diagnosis had significantly better results (90.1) than patients with chronic tendon injuries (72.6 points). Conclusion. Good results of acute rupture reconstruction are achieved by transosseous techniques or suture anchors. The surgery is much more complicated in neglected and chronic ruptures, and the results are worse. Surgical procedures, such as the patellar tendon reconstruction by bone-tendon-bone graft, additionally strengthened with wiring and screws, contribute to stable fixation, enable early rehabilitation, and prevent stiffness and muscle weakness.

Technique for Fixation of Semitendinosus to the Patella in Patellar Tendon Reconstruction

Chronic patellar tendon injuries are rare yet challenging to treat. Timing of surgery and graft choices are debatable. Many techniques and methods of fixation have been described with pros and cons. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique. In this Technical Note, we use distally based semitendinosus (ST) looped over 2 ETHIBOND sutures. The ETHIBOND is passed through 2 vertical tunnels in the patella and retrieved proximally, docking the ST in a blind tunnel created in the lower pole of the patella. The whip-stitched free ST end is passed through a tunnel behind the tibial tubercle and sutured back to its base. A polyester tape is used to augment the repair in a circumferential manner. Postoperatively full weight bearing is allowed as tolerated in a hinged knee brace locked in extension with only passive range of motion of 0-90° allowed for 6 weeks.

Patellar tendon reconstruction with hamstring autograft for the treatment of chronic irreparable patellar tendon injuries

BackgroundPatellar tendon injuries not amenable to primary repair present a challenging problem for surgeons and patients alike. No standard surgical technique exists for these injuries and few studies report outcomes after surgical treatment. MethodsA retrospective analysis was conducted for patients undergoing surgical treatment for irreparable patellar tendon tears. Patients were treated with an indirect tendon reconstruction technique using high-strength suture to set initial patellar height and hamstring autograft for biologic augmentation. Patients who underwent this procedure between 2012 and 2018 and met minimum two-year follow-up with completion of all outcome measurements including KOOS, PROMIS, VAS pain and satisfaction scores were included. ResultsEleven patients met inclusion criteria. Ten of eleven patients (91%) had intact repairs and final patient outcomes were collected at a mean of 54.9 ± 23.1 months after surgery. Only one patient experienced extensor lag at final follow-up (p < 0.001). The preoperative Caton–Dechamps ratio was 1.77 ± 0.58, which decreased to 0.98 ± 0.25 after surgery (p < 0.001). The mean postoperative KOOS ADL score was 61.5. The mean postoperative PROMIS Global Mental and Physical Health scores were 46.9 ± 8.7 and 42.0 ± 9.8. Post-operative mean VAS satisfaction score was 5.6 ± 3.4. ConclusionsPatellar tendon reconstruction with autologous hamstring tendon graft and suture augmentation allows for acceptable outcomes in the setting of patellar tendon disruption with segmental defects when direct repair is not possible.

Clinical and Biomechanical Outcomes following Knee Extensor Mechanism Reconstruction

PurposeTo evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR).MethodsPatients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset.ResultsFrom 2011 to 2018, 12 patients (12 knees, 10 male, 5 right, mean age: 54.3 ± standard deviation: 15.2 years) with KEM injuries requiring tendon reconstruction with a 1-year minimum follow up were identified. Postoperative follow-up was 42.6 months (range: 12.0-93.0 months). Procedures included patellar (7) and quadriceps tendon reconstruction (5). Postoperative versus preoperative Tegner Activity Scale scores demonstrated significant improvement (3.5 ± 2.5 vs 1.5 ± 1.2, n = 8, P = .05). Postoperative versus preoperative Kujala scores significantly improved (70.3 ± 11.7 vs 43.6 ± 15.7, n = 8, P = .010). There was significant improvement in preoperative to postoperative KEMR extension lag (29.4 ± 22.2° vs 0.83 ± 1.9°, P = .002). Clinically, there was no difference in passive range of motion between the operative and contralateral knee. BioDex testing demonstrated decreased maximum work generated from the operative versus contralateral knee at slow (70.4 ± 30.4 Joules vs 101.9 ± 40.6 J; P = .028), intermediate (52.0 ± 45.4 J vs 69.8 ± 63.7 J; P = .038), and fast (43.8 ± 41.7 J vs 57.5 ± 53.8 J; P = .050) speeds. Range of motion was less in the operative versus contralateral knee at all speeds: P = .011, .038, and .024. The average peak torque generated per body weight was smaller in the operative versus contralateral knee at slow speed (P = .038).ConclusionsPatients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively.Level of EvidenceTherapeutic Case Series, Level IV.

Revision Patellar Tendon Reconstruction in Prosthetic Joint Infection following Total Knee Arthroplasty - A Case Report

Patellar tendon rupture is a rare but devastating complication following total knee arthroplasty. We report a case of a failed patellar tendon reconstruction and prosthetic joint infection following patellar tendon rupture. The objective of this case report is to highlight the favorable outcome following revision patellar tendon reconstruction with a synthetic graft and two stage revision arthroplasty.

Successful mid- to long-term outcome after reconstruction of the extensor apparatus using proximal tibia-patellar tendon composite allograft.

The purpose of the study was to assess the outcomes of extensor mechanism reconstruction with proximal tibia-patellar tendon composite allograft. 24 consecutive patients treated with allograft-prosthetic composite for proximal tibia tumour resection and a conventional total knee arthroplasty were included. Extensor mechanism reconstruction was performed with a proximal tibia-patellar tendon composite allograft and the suture of the donor tendon to the remnant native patellar tendon. Function was evaluated by the Musculoskeletal Tumor Society score (MSTS) and range of motion. Western Ontario and MacMaster University (WOMAC) and visual analogue scale for pain also were used. After a mean follow-up of 11.7 (range 3-15) years, mean MSTS score was 22.4 (range 20-30), mean flexion was 94.0° (range 84°-110°), and mean extension lag was 7.2° (range 0°-18°). The mean VAS-pain was 4.3 (range 2-6), and WOMAC score was 72.4 (range 58-100). There was no failure of the reconstructed extensor mechanism. Patellar tendon reconstruction with allogeneic tissue from the proximal tibia allograft sutured to the recipient's remnant patellar tendon provides the mechanical support needed for healing of the reconstructed extensor mechanism with a substantial functional benefit to stabilize active knee extension and successful reconstruction survival at long-term. III.

Which role for synthetic ligaments in the reconstruction of patellar tendon chronic rupture after TKA? Mid-term outcomes using LARS ligament.

Background and aim of the work:Patellar tendon rupture is a rare complication after Total Knee Arthroplasty (TKA) which always requires surgical treatment. Patients with chronic lesions or tendon degenerations showed good results at short-term follow-up (FU) when treated using autografts or allografts, but these techniques showed poor outcomes at long-term FU. Moreover, allografts have high costs and limited availability, not to mention the increased risk of immune reactions and infections. Recently, the use of synthetic ligaments for patellar tendon reconstruction has taken hold with encouraging results. We report our experience in the treatment of patellar tendon ruptures after TKA using the Ligament Advanced Reinforcement System-LARS®.Methods:Clinical evaluation was performed using the Knee Society Score and recording extensor lag. Instrumental evaluation was performed using ultrasound imaging to assess patellar tendon thickness and using conventional x-rays to assess prosthesis’ mobilization signs and patella’s height.Results:At the final FU, 6 knees were included in our study. Patient’s mean age was 66.7. Patellar tendon reconstruction occurred after a mean time of 4 months from the previous surgery. The mean FU was 44,2 months. The mean Knee Score was 63.3 and the mean Function Score was 35. In 4 knees the extensor lag was < 10° while in 2 knees it was > 20°. The mean ISI was 1.16, while the average increment in tendon thickness was 127.12%.Conclusions:In our opinion, synthetic ligaments can be successfully employed for the reconstruction of patellar tendon breakage after TKA and rTKA in selected patients, in order to quickly return them to their activity of daily living. (www.actabiomedica.it)