Patellar Tendon Rupture Research Articles

Complications following total knee arthroplasty in patients with prior extensor mechanism dysfunction: A retrospective review

BackgroundExtensor mechanism disruption following total knee arthroplasty (TKA) is a rare, yet serious complication. While previous patellar abnormalities are a theoretical risk factor for this complication, there is a scarcity of literature describing the impact of prior extensor mechanism dysfunction (EMD) on this and other complications following TKA. In this study, we describe our institutional experience with complications following TKA after EMD. MethodsSixty-one knees that underwent total knee arthroplasty between April 2007 and April 2023 in patients with previous EMD were identified. Extensor mechanism dysfunction types included patellar fracture, patellar tendon rupture, patellar realignment surgery, previous patellar dislocation, and a chronic laterally tracking patella impacting extensor mechanism function. Primary outcomes included extensor mechanism failure, infection, dislocation, aseptic loosening, revision surgery, and stiffness requiring manipulation under anesthesia (MUA). ResultsA total of 61 knees, comprised of 53-patients, were included. There were complications witnessed in fifteen patients, leading to a 24.6 % overall complication rate. There was one extensor mechanism disruption in the form of a partial quadriceps tendon tear requiring repair. There was one patellar dislocation requiring reoperation. There were five superficial infections successfully treated non-operatively and four deep infections requiring reoperation. A total of nine reoperations were performed, four of which were revisions. Four patients underwent MUA due to severe post-operative stiffness. ConclusionIn this study, we found a high complication rate following TKA in patients with previous extensor mechanism dysfunction. There was one case of partial quadriceps tendon rupture requiring repair.

Patellar Tendon Ruptures after Total Knee Arthroplasty.

Patellar tendon (PT) rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. PT ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life. In complete ruptures of the PT, repair or reconstruction is typically indicated; however, complication rates following intervention remain high. Operative intervention remains the mainstay of treatment, with only certain specific situations where nonoperative intervention is appropriate. Operative techniques are chosen based on the acuity, location of disruption, and status of the residual soft tissues. Treatment options include repair with or without augmentation or reconstruction. Augmentation does reduce the high risk of complications, bringing rates down from 63 to 25%. Augmentation options include autografts, allografts, synthetic grafts, or synthetic meshes. Despite advancements, outcomes are unpredictable and complications are common, highlighting the need for further research to improve treatment protocols. This article provides an overview of PT ruptures following TKA, the various treatment options, and the recommendations of the M.M., R.D., G.S. for each common type of PT injury encountered.

Patellar Tendon Reconstruction Using Quadriceps, Semitendinosus, and Gracilis Autografts With Ultra-high Molecular Weight Polyethylene Tape Augmentation: A Novel Technique

Background: Chronic patellar tendon ruptures are challenging injuries to treat and can be debilitating to patients. Optimal treatment of these extensor mechanism injuries occurs in the acute postinjury period. When these injuries become chronic, they are increasingly difficult to treat effectively. Purpose: We present a case of chronic patellar tendon rupture in a young athletic male who was treated with quadriceps, semitendinosus, and gracilis autograft. To our knowledge, there have been no other reports of using a quadriceps autograft with a bone plug to reconstruct a chronic patellar tendon injury. Patients and Methods: A healthy male under the age of 18 presented in a delayed manner to our clinic with complaints of left knee pain and inability to straighten the knee. His imaging and clinical exam found that he had a patellar tendon rupture, ∼15-degree extensor lag, flexion to 140 degrees, and was unable to straight leg raise or perform any active extension of the knee. He had significant atrophy of his vastus musculature at the knee. The rupture was treated with quadriceps, semitendinosus, and gracilis autograft. Results: At 6 months follow-up, our patient had achieved full extension, flexion to 135 degrees, and 4 of 5 quadriceps strength. He returned to routine physical activity and was satisfied with his results to date. At 1 year’s follow-up, the patient had full extension and flexion to 140 degrees and had resumed playing recreational soccer. Conclusion: Treating chronic patellar tendon rupture with quadriceps, semitendinosus, and gracilis autograft resulted in a positive outcome for this difficult-to-treat injury.

Does Resurfacing the Patella Increase the Risk of Extensor Mechanism Injury within the First 2 Years after Total Knee Arthroplasty?

Extensor mechanism injury (EMI) following total knee arthroplasty (TKA) is a potentially catastrophic complication and may lead to significant morbidity or need for revision reconstructive procedures. Patellar resurfacing (PR), while commonly performed during TKA, reduces overall patella bone stock and may increase the risk of EMI after TKA. The purpose of this study was to assess if PR in elderly patients raises the risk for subsequent EMI.The American Joint Replacement Registry (AJRR) was queried to identify Medicare patients ≥65 years old undergoing primary elective TKA for osteoarthritis between January 2012 and March 2020. Patient age, sex, and Charlson Comorbidity Index (CCI) were collected. Records were subsequently merged with Medicare claims records and evaluated for the occurrence of patella fracture, quadriceps tendon rupture, or patellar tendon rupture based on International Classification of Diseases 9 and 10 (ICD 9/10) diagnosis codes within 2 years of TKA. Patients were stratified based on whether PR occurred or not (NR). Logistic regression was used to determine the association between PR and EMI.A total of 453,828 TKA were eligible for inclusion and 428,644 (94.45%) underwent PR. The incidence of PR decreased from 96.06% in 2012 to 92.35% in 2022 (p < 0.001). Patients undergoing PR were more often female (60.93 vs. 58.50%, p < 0.001) and had a lower mean CCI (3.09 [1.10] vs. 3.16 [1.20], p < 0.001). Odds for EMI did not differ based on whether PR was performed (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.65-1.11, p = 0.2246). Increasing age (OR: 1.06, 95% CI: 1.05-1.07, p < 0.0001]) and CCI (OR: 1.06, 95% CI: 0.95-1.19, p = 0.0009) were associated with EMI.PR is commonly performed during TKA in the United States and was not found to increase odds for EMI within 2 years of TKA in patients ≥65 years old. Increased age and medical comorbidity were associated with higher odds for subsequent EMI.

Patellar Tendon Reconstruction Using Hamstring Graft: A Case Report

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 out- comes and there is no consensus on standard of care. Indications: The patient is a young female of 18yrs who presented with a history of trauma to right knee and was diagnosed with chronic patellar tendon tear. The patient was indicated for patellar tendon reconstruction with autologous hamstring tendon graft due to chronicity of the injury. Method: Patellar tendon reconstruction using hamstrings graft and fixing with anchor suture and interference screw. Result: Achieving normal patella tendon height and complete range of motion with restoration of extensor mechanism of knee. Conclusion: Knee extensor mechanism disruptions necessitate prompt surgical correction. In patients with poor tendon quality and/or a history of knee arthroplasty, primary repair should be supplemented with autograft or allograft. Early repairs yield better results than late interventions, which necessitate intricate reconstructions to reestablish the extensor mechanism's continuity. Achieving early osteointegration of the graft is important in case of tendon reconstructive procedures such as in this case as it leads to better outcomes in terms of rehabilitation and early progress to daily activities. Keys Words: tendon injuries, patellar tendon reconstruction, chronic patellar tendon tear, hamstring graft, hamstring tendon autograft, interference screw

Reconstruction of a Chronic Patellar Tendon Rupture: A Case Report

Reconstruction of a Chronic Patellar Tendon Rupture: A Case Report

Patellar tendon restoration techniques: a systematic review of outcomes for repair and reconstruction methods.

This systematic review aims to delineate the various methods to repair or reconstruct the patellar tendon using the available literature. MEDLINE and PubMed electronic databases were searched for English language clinical studies involving patellar tendon rupture repair or reconstruction that reported patient-reported outcome scores (PROS) between January 1st, 1953 and June 17th, 2021. Data was extracted on full text articles to collect functional outcome scores and rupture category, including acute, chronic, post-total knee arthroplasty (TKA) and post-anterior cruciate ligament reconstruction (ACLR). Twenty-three studies with a total of 738 patients were included. Of the 14 studies including acute repairs, mean postoperative Lvsholm scores ranged from 84 to 99.5. Knee Society Score (KSS) and knee range of motion (ROM) measurement were the most widely reported outcomes in the chronic setting. The average postoperative KSS scores ranged from 70 to 87.7. Of the six studies that included patellar tendon repairs/reconstructions in the setting of prior TKA, the most frequently reported outcomes were KSS scores and knee ROM measurements. The average postoperative KSS scores for the three cohorts reporting reconstruction with allograft ranged from 79 to 88 as compared to the average postoperative KSS score for reconstruction with autograft of 70. Despite this heterogeneity, we concluded: (1) in the primary setting, cerclage augmentation yields the lowest lysholm scores and should not be considered, although primary repairs with and without augmentation yield comparable postoperative lysholm scores, (2) in the chronic setting, repair with augmentation and reconstruction yielded similar results aside from in post-TKA patients where allograft reconstruction yielded superior KSS scores.

Patellar Tendon Rupture with Intact Overlying Prepatellar Quadriceps Continuation: A Case Report

Patellar Tendon Rupture with Intact Overlying Prepatellar Quadriceps Continuation: A Case Report

Treatment outcome of chronic patellar tendon rupture using autogenous semitendinosus graft: a retrospective case series.

This study highlights the pattern of presentation, treatment, early functional outcome, and complications observed in the management of chronic patellar tendon ruptures using our preferred technique of autogenous semitendinosus graft reconstruction. This was a retrospective case series involving consecutive patients who underwent patellar tendon reconstruction and met the inclusion criteria. The outcome measures were determined by thepost-operative knee range of motion (R.O.M), thepost-operative International Knee Documentation Committee (IKDC) score, and pattern of post-operative complications. Nine patients were included in this case series. The mean age of the patients was 35.4 ± 6.8years (range 27-44years). Trauma to the knee accounted for majority of the cases (62.5%). Six (66.7%) of the nine patients suffered a patellar tendon rupture from contact injury during sporting activities. The mean length of time from injury to presentation was 20.5 ± 11.2weeks (range 6-69.5weeks). Normal knee function in a case (11.1%), nearly normal knee function in 7 cases (77.8%), and abnormal knee function in a case (11.1%) were recorded as a measure of outcome of surgery. The mean post-operative IKDC score was 70.0 ± 6.1 (range 55-77), which was higher than the mean pre-operative score of 26.4 ± 5.1 (range 18-32). The post-operative knee R.O.M averaged 97.2 ± 16.2° (range 70-120°) with a single case with a 10° extension lag noted. Normal to near-normal knee function was obtained with the treatment of chronic patellar tendon rupture in the majority of cases using autogenous semitendinosus graft for patellar tendon reconstruction in our series.

Poster 298: Complications Following Tibial Tubercle Osteotomy (TTO) at a Tertiary-Care Institution

Objectives: Tibial tubercle osteotomy (TTO) can be used to treat patellar instability, patellar maltracking/compression, and patellofemoral cartilage damage. Reported complication rates following TTO range from 1% to 46%, with varied definitions of complication. The purpose of our study was to define the incidence of complications following TTO in a large cohort at a tertiary-care institution. Methods: Patients who underwent TTO between 2011 and 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up were excluded. Revision cases were excluded. Information about complications was obtained through review of the electronic medical record. Major complications included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, re-dislocation, reoperation for other indications, readmission, and revision. Minor complications included superficial infection, deep venous thrombosis (DVT), wound dehiscence, and postoperative neurapraxia. Chi-square tests were used for categorical variables, t tests for continuous variables. Results: Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years. Patients were 68.5% female with average age 28.3 years.The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of patients, and minor complications in 8.4% of patients. Reoperation was required in 16.6% of patients at an average of 14 months after index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (5.0%). These and other complications are reported in Table 1 at 30 days, 90 days, 1 year, and final follow-up. Table 2 compares patient characteristics for those who had a major complication versus those who did not. Patients who had a major complication were older than those who did not (30.2 vs 27.7, p = .013). A higher proportion of patients who had a major complication had a previous ipsilateral surgery (57.5% vs. 36.6%, p &lt; .001), had an indication of cartilage lesion/arthritis (71.7% vs. 60.6%, p = .034), and underwent a concomitant cartilage reconstruction/repair procedure (51.8% vs. 39.1%, p = .012). A lower proportion of patients who had a major complication had an indication of instability (56.6% vs. 67.2%, p = .043) and underwent a soft tissue reconstruction (46.4% vs. 60.1%, p = .012). There were no differences in the proportion of major complications by sex or American Society of Anesthesiologists score. Mean body mass index (BMI) did not differ significantly between patients who had a major complication and those who did not. Hardware removal was required in 6.5% of patients. More patients with headed as compared to headless screws required hardware removal (13.2% vs. 1.7%, p &lt; .001). Arthrofibrosis requiring reoperation was observed in 5.7% of patients. A significantly higher proportion of patients who underwent a concomitant cartilage restoration/repair procedure had arthrofibrosis postoperatively (10.0% vs. 2.5%, p &lt; 001). There was no difference in arthrofibrosis requiring reoperation by race, sex, age, BMI, smoking status, prior ipsilateral surgery, or other concomitant procedures. Conclusions: The complication rate following TTO was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and a reoperation rate of 16.6% at a mean follow-up of 1.9 years. Major complications were observed in 23.7% of patients and were more common in older patients, patients with an indication of cartilage lesion/arthritis, patients who underwent a cartilage restoration/repair procedure, and patients with a previous ipsilateral surgery. Hardware removal was more common in patients with headed screws. Arthrofibrosis was more common in patients who underwent a concomitant cartilage restoration/repair procedure.

Surgical treatment of patellar tendon rupture after total knee arthroplasty with a double-row repair method using the hamstring tendons: A novel technique with functional results.

Patellar tendon rupture (PTR) is extremely rare but serious complication after primary or revision total knee arthroplasty. Due to the serious failure rates of end-to-end repair techniques, various augmentation techniques have been described. In this study, the results of patients with PTR after reconstruction using our own technique with semitendinosus (ST) and gracilis tendons taken from the affected side were evaluated retrospectively. A total of 14 patients, whose diagnosis was made based on physical examination and clinical findings, and supported radiologically (ultrasonography), were included in the study. In these patients, reconstruction was performed using double-row repair technique with the ST and gracilis tendons. Active-passive knee joint range of motion, active knee extension loss, and the Caton-Deschamps index at preoperative and final follow-up visits were compared. Tegner-Lysholm knee score and Kujala score were used to evaluate functional results. In 14 patients (8 women and 6 men) with a mean age of 68.1 years, the median time between injury and surgery was 6.6 weeks. In all patients, the rupture was in the distal part of the patellar tendon. While the median preoperative Caton-Deschamps index was 1.8, the postoperative median value was found to be 1.25 after an average follow-up of 3.8 years (P = .014). The median preoperative knee extension loss decreased from 25° to 5° postoperatively. Tegner-Lysholm knee score and Kujala score of the patients at their last follow-up were significantly increased (P < .01). For PTR developing after total knee arthroplasty, the double-row reconstruction technique with ST and gracilis tendons is effective.

Influence of Changes in Patella Indices on Total Knee Replacement Surgery Outcomes.

Total knee replacement is increasingly widely prescribed, not only for degenerative joint disease but also for other problems such as articular cartilage disease, misalignment due to causes other than degeneration, bone and joint cancer, and diseases that cause joint destruction. However, changes in knee joint biomechanics as well as complications of the patellofemoral joint after surgery lead to instability, joint pain, patellar rupture, and patellar tendon rupture. These are issues that challenge surgeons as well as make patients hesitant when considering knee replacement surgery. Understanding the changes in patella index that can occur after total knee replacement surgery will help surgeons carefully evaluate patients before surgery and calculate intraoperative techniques to minimize complications. Fifty-eight patients with 62 knees were diagnosed with osteoarthritis and underwent total knee replacement surgery. All patients had clinical and radiographic evaluation of the knee joint before and after surgery. Patellar indexes did not change significantly after surgery compared to before surgery. Before surgery, 2 patients (3.23%) had true patella baja. After surgery, 7 patients (11.29%) had true patella baja and 3 patients (4.84%) had pseudo-patella baja. The average knee flexion amplitude after surgery was 103.11±15.440, with only 2 patients losing extension >50º. The average KS score after surgery was 83.69±9.98, significantly improved compared to before surgery 33.44±11.38. Similarly, KFS score after surgery was 81.01±8.84 compared to before surgery 37.05±8.08. Changes in index of the patella before and after surgery affect the surgical results, the normal patella group has better results than the group with patella baja.

Acute Patellar Tendon Ruptures: An Update on Management.

Patellar tendon ruptures can be debilitating injuries. When incomplete, partial tears can be managed nonsurgically with immobilization and progressive rehabilitation. Although complete ruptures remain a relatively uncommon injury, they portend a high level of morbidity. Ruptures typically result from an acute mechanical overload to the extensor mechanism, such as with forced quadriceps contraction and knee flexion. However, chronically degenerated tendons are also predisposed to failure from low-energy injuries. Diagnosis can often be made clinically with recognition of a palpable defect to the tendon, localized patellar tendon tenderness, and inability to actively extend the knee. Diagnosis and surgical planning can be established with radiograph, ultrasonography, or magnetic resonance imaging. Surgical repair is the mainstay of treatment, and there have been many recent advances in repair technique, optimal reconstruction strategies, and supplemental fixation. Time to surgery for complete tears remains the most important prognosticator for success. Direct primary repair can be completed with transosseous tunnels, suture anchor repair, or end-to-end repair. Tendon reconstruction can be achieved with or without mechanical or biologic augments. Rehabilitation programs vary in specifics, but return to sport can be expected by 6 months postoperatively.

Krackow technique in patellar tendon rupture with tibial tuberosity avulsion with anterolateral rim of tibial plateau fracture: A case report

: Simultaneous occurrence of patellar tendon rupture and tibial tuberosity avulsion with anterolateral rim of tibial plateau fracture is an extremely rare condition that mainly occurs in adolescent population involved in sports activities. It is believed to be due to eccentric contraction of the extensors with the leg fixed to the ground. : The author present a case of 42 years old male patient who suffered an avulsion fracture of the tibial tuberosity with anterolateral rim of tibial plateau with rupture of patellar tendon in road-traffic accident which is rarely seen. : It was treated with open reduction with cannulated cancellous screw insertion and tension band wiring and patellar tendon repair by krackow technique which showed excellent results post-operatively. The pathophysiology, mechanism of injury, diagnosis and management of this case is reviewed in this article.

Low Tensile Strength Suture With Transosseous Tunnels and Suture Anchors 5 mm in Diameter or Greater Are Associated With Higher Failure Rates in Primary Patellar Tendon Repair

To determine the rate of and risk factors for clinical failure and return to military duty following primary patellar tendon repair with either transosseous trunnel repair or suture anchor repair. The Military Health System Data Repository (MDR) was queried to identify all adult patients undergoing surgical treatment of a patellar tendon rupture in the Military Health System from 2014 to 2018. Patients who underwent either transosseous tunnel repair or suture anchor repair were included. Health records were examined to collect additional data. Univariate analysis and multivariate logistic regression models were used to determine independent risk factors for rerupture. A total of 450 knees in 437 patients were included. Transosseous tunnel repair was the most frequently used technique (314/450, 77%), followed by suture anchor repair (113/450, 25%). Rerupture occurred in 33 knees (7%). There was no difference in rerupture rate between transosseous tunnel repair and suture anchor repair (P= .15), and this result persisted within the multivariate logistic regression model. Among transosseous tunnel repairs, use of low tensile strength suture was an independent risk factor for repair failure (odds ratio [OR], 3.4; P= .016). Among suture anchor repairs, use of anchors 5.0 mm in diameter or greater (OR, 12.0; P= .027) was an independent risk factor for repair failure. There is no statistically significant difference in failure rate between transosseous tunnel repair and suture anchor repair in primary patellar tendon ruptures. However, the use of low tensile strength suture with transosseous tunnels and the use of suture anchors 5.0 mm in diameter or greater resulted in significantly higher failure rates. These data suggest that use of high tensile strength suture in transosseous tunnel repair and use of suture anchors less than 5.0 mm in diameter in suture anchor repair result in lower failure rate in primary patellar tendon repair. Level III, retrospective cohort study.

Patellar and quadriceps tendon rupture are associated with hip fracture in hemodialysis patients with severe hyperparathyroidism.

Spontaneous rupture of the patellar (PTR) and quadriceps (QTR) tendon is infrequent. Systemic diseases such as diabetes mellitus, CKD, and secondary hyperparathyroidism (SHPT) are risk factors. The present cohort study aimed to evaluate risk factors associated with tendon rupture in hemodialysis (HD) patients with SHPT, as well as outcomes including surgical complications, re-ruptures, and fracture. Baseline clinical, laboratorial data, and radiographs were analyzed. Patients were followed up from March 2012 to March 2020. One-hundred thirty-one patients (≥18yr of age, on HD ≥ 6mo, with SHPT) were included. Incidence rates of PTR and QTR were 2.3 and 1.7/10000 HD patients/yr, respectively. The mean age of patients with tendon rupture was 44.0 ± 11.2yr. These patients exhibited higher serum levels of phosphorus (6.3 ± 1.5mg/dL vs 5.6 ± 1.1mg/dL; P = .005), PTH (2025.7 ± 667.6pg/mL vs 1728.4 ± 684.8pg/mL; P = .035), and C-reactive-protein (35.4 ± 32.9mg/dL vs 17 ± 24.5mg/dL; P = .002) compared to the group without tendon rupture. The mean follow-up was 56.7 ± 27.1mo. No patient required a new surgical approach or experienced re-rupture. Of all patients, 31% experienced hip fracture: 50% in the group with rupture (29.5 ± 17.4mo after the tendon rupture) vs 26% without tendon rupture (P = .015). After adjustment, the hazard ratio for hip fracture was 2.87 (95% CI, 1.27-6.49; P = .012). Patients with SHPT and high levels of phosphorus, PTH, and inflammatory markers were at greater risk for tendon rupture. Surgical complication rates were low. However, results suggest that tendon rupture of knee extensor mechanism in HD patient with SHPT should be regarded as a "red flag" for future hip fracture.

Rehabilitation exercise program after surgical treatment of patellar tendon rupture: A case report

ObjectiveThis case report describes in detail a rehabilitation and exercise program following surgical treatment of patellar tendon rupture and offers postoperative therapeutic goals and recommendations, with the aim of expediting the resumption of activities of daily living and sports participation following the surgical procedure. In addition, this report analyzes the cause of the patellar tendon rupture in this case. DesignCase report. ParticipantsThe patient, a 25-year-old male recreational athlete (height: 184 cm; weight: 80 kg; right-hand dominant), experienced a complete rupture of the patellar tendon upon landing on the left lower extremity during an unopposed dribble turn. Rehabilitation exercise programA well-structured rehabilitation program was implemented. Passive knee flexion range of motion (ROM) exceeded 90° at week 5 and was fully recovered at week 16. A second surgery was performed at week 19 to remove the decompression wires, and the patient progressively resumed basic physical and specialized training at 7 months post-surgery. Main outcome measuresMorphometric and functional tests were performed to measure the effectiveness of rehabilitation throughout the postoperative process. ConclusionsEarly surgical repair and an immediate postoperative rehabilitation program have a positive impact on knee ROM, function, and muscle strength. The causes of the patellar tendon rupture in this patient included long-standing uncontrolled patellar tendinopathy, impaired mobility of the ankle and hip joints, poor landing technique, and muscle strength imbalances.

Regeneration of the Patellar Tendon with Radial Pressure Waves in a Sharp Injury: Case Report

Patellar tendon ruptures are rare injuries and are more commonly associated with predisposing factors and previous surgical procedures than with direct trauma. Acute partial-thickness tears are usually treated with immobilization and rehabilitation. The literature recommends surgical management of partial ruptures of the patellar tendon after 6 months of failure of conservative treatments and in acute cases with a compromise &gt;50–55% of the tendon. Radial pressure wave therapy is a safe, non-invasive technique with scientific support in tissue regeneration; it is found as one of the therapeutic alternatives for the management of tendinopathy and partial ruptures of the patellar tendon. The present case report shows the effectiveness of radial pressure wave therapy in a shear injury of the patellar tendon, with a compromise of at least 70%. We have not found similar cases previously reported in the literature, highlighting its relevance. Keywords: Patellar tendon, Radial pressure waves, Patellar tendon rupture, Cutting injury

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.

Acute Patellar Tendon Rupture with a Z-Shaped Pattern from the Inferior Pole of the Patella to the Tibial Tubercle

Acute Patellar Tendon Rupture with a Z-Shaped Pattern from the Inferior Pole of the Patella to the Tibial Tubercle