Patellar Tendon Rupture Research Articles

Is there a relation between length of stay and early complications rate after total knee arthroplasty? Results of 1065 patients

Introduction The number of total knee replacements is rapidly increasing as a result of population ageing. Trying to decrease the costs associated with this procedure, there is an increased effort to diminish hospital length of stay without raising the complications rates. Aim Evaluate if there is a relationship between a decrease in hospital's length of stay and early complications within 30 days postoperatively and all-cause readmissions within 30 days after discharge. Material and methods Retrospective revision of 1065 patients submitted to total knee arthroplasty between July 2007 and June 2013 in our institution. Data was collected by analyzing patient's records, in what regards early complications and readmissions within the first 30 days after discharge and the length of stay in hospital after surgery. The statistical analysis was performed using SPSS v22. Significance was defined as P Resultats The population of the study is composed of 1065 patients. The length of stay decreased from 5.18 ± 2.28 days between July 1st 2007 and September 31st 2007, to 4.76 ± 3.2 days between April 1st 2013 and June 30th 2013. Observed complications were 49 (4.6%), with 19 (1.8%) infectious events, 10 (0.9%) suture dehiscences, 9 (0.8%) hemorrhagic events, 3 (0.3%) thromboembolic events, 3 (0.3%) gastrointestinal events, 1 (0.1%) periprosthetic fracture, 1 (0.1%) miocardial infarction, 1 (0.1%) acute renal failure, 1 (0.1%) patellar tendon rupture, 2 (0.2%) deaths. All-cause readmission rate within 30 days after discharge was 6.1%. Discussion There is a decrease in the total length of stay. This is due to the current trend about decreasing hospital length of stay after TKA and positive feedback from the Rehabilitation department. It can be observed a low rate of complications in what concerns DVT, hemorrhagic events and other events like gastrointestinal or renal, which reinforces the confidence of safe earlier discharges. The infection and DVT rates are low when considering the published literature. There are limitations in what concerns the time frame, it is a short postoperative period. Hospital records always have the limitation of underreporting these events. The association between length of stay and early complications rate was not significant (P = 0.2019) as well as all-cause readmission rate (P = 0.280). Conclusion It was not found any significant association between length of stay and both early complications rate and all-cause readmission rate. These findings are similar to other studies and reinforce the current trend about short stays after total knee replacements, which is better for patient safety and cost control.

Surgical Technique to Bring Down the Patellar Height and to Reconstruct the Tendon for Chronic Patellar Tendon Rupture

Although surgical treatment is the gold standard for chronic patellar tendon rupture, the technique of patellar tendon reconstruction is still difficult. Basically, good clinical results of surgical repair for acute patellar tendon rupture have been reported. However, the results of reconstructive surgery for chronic patellar tendon rupture are still inconsistent. Some surgical options have been previously reported. For example, surgeons need to choose between 1- and 2-stage reconstruction. Furthermore, contralateral bone-tendon-bone graft, ipsilateral semitendinosus tendon graft, Achilles tendon allograft, and an artificial ligament have been used to reconstruct the patellar tendon. Generally, surgeons are concerned about postoperative complications, including loss of knee flexion, quadriceps weakness, and wound problems. One of the key points to avoid these complications is to improve proximal patellar migration. The purpose of this article is to present an easy and safe technique to bring down the patellar height with polyethylene tape and to reconstruct the patellar tendon with an artificial ligament. Although it has limitations, the described technique can facilitate reconstruction of chronic patellar tendon rupture.

Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature

BackgroundIntact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased. ObjectiveTo evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries. MethodsDemographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score. ResultsFive male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12–15 years). The injury occurred in relation to sports activities in 4 patients. Osteogenesis imperfecta and Osgood-Schlatter disease were identified in 2 patients. High riding patella is the hallmark diagnostic sign detected in plain x-ray with preoperative Insall-Salvati ratio ranged from 1.7 to 2.5. Three patients had pure soft tissue avulsion distally from the proximal tibia, 1 patient had pure soft tissue avulsion proximally from the inferior patellar pole, and 1 patient with midsubstance tendinous disruption. No associated intra-articular lesions were identified. Suture bridge double row technique, transpatellar suturing, and transosseous suturing through the proximal tibia were used for patellar tendon reinsertion. After a mean follow-up period of 18. 4 weeks (range: 10–30 weeks), patients achieved AROM ranging from 0 to 120° to 0–137° without terminal extension lag. The mean time to return to sports activity was 22 weeks (range: 13–30 weeks). Quadriceps muscle strength was 5/5 at the final follow-up visit in all patients; however, relative muscle atrophy was noted in comparison to the other side in one patient. The mean KSS was 91.8 points (range: 79–100 points) with excellent outcome in 4 patients and good outcome in 1 patient. ConclusionPatellar tendon rupture is rare in the pediatric population and represents 7% of pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. Ruptures may occur midsubstance, or from proximal or distal insertions. High riding patella is the hallmark diagnostic sign for such injury. Although rare, it is considered a serious injury that necessitates early diagnosis and surgical intervention. Functional range of motion was obtained in all patients with different modalities of treatment.

Neglected patellar tendon rupture after revision total knee arthroplasty

Neglected patellar tendon rupture after revision total knee arthroplasty

TREATMENT OF INSUFFICIENT JOINT EXTENSOR MECHANISM IN PRIMARY AND REVISION KNEE REPLACEMENT

Insufficiency of the knee joint extensor mechanism is the absolute contraindication for total knee arthroplasty. Therefore, it is necessary to restore the extensor mechanism before arthroplasty or to change the treatment approach.Purpose of the study – to evaluate the outcomes of surgical reconstruction of the knee joint extensor mechanism during primary or revision knee arthroplasty.Materials and methods. 25 reconstructions of extensor mechanisms (24 patients) were performed in the period from 2006 to 2015. Five procedures out of 25 were performed in primary TKA and 20 in revision TKA. Indications for extensor mechanism reconstruction were as follows: patellar tendon rupture in 15 cases (60,0%), fracture of patella in 5 cases (20,0%), quadriceps tendon rupture in 3 cases (12,0%) and other indications in 2 cases (8,0%). One of the following four techniques was used to restore the extensor mechanism: “Frame / Loop” allograft of patellar tendon in 6 cases (24,0%); bone – patellar tendon – bone allograft in 9 cases (36,0%); quadriceps tendon – patella-patellar tendon – bone allografts in 7 cases (28,0%); weber’s internal fixation of patella in 3 cases (12,0%).Results. All patients were evaluated based on clinical examination, KSS and WOMAC scores (18 patients), and standard x-rays (13 patients). The mean follow-up period in the present study was 44 months postoperatively. Reconstruction of the knee joint extensor mechanism resulted in a significant reduction of pain in 38.8% of patients, the knee stability was restored in 83,3% of patients and the active knee extension improved significantly in the vast majority of patients.Conclusion. Despite the objective improvement of the knee joint function after the reconstructions of extensor mechanism, the KSS and WOMAC evaluation scores remained low which should be taken into consideration during preoperative planning.

Le vie d’accesso alla riprotesizzazione del ginocchio

Total knee arthroplasty is nowdays a safe and reliable procedure in order to pain relief and restore function. Despite the good outcomes in long-term follow-up, the changing in demographics and the growing of surgical procedures, will increase the number of revisions. During the approach to total knee revision, the exposure is often the first issue, which must be addressed step by step. Skin incision must be decided according to previous scars or to varus/valgus deformity. Knee joint can be exposed firstly from a standard medial/lateral parapatellar approach. After scar tissue removal, if the exposure is not sufficient, or the risk of patellar tendon rupture is serious, an extensile approach is necessary. Quadriceps snip is usually the first approach performed, because of the possibility of safe patellar eversion without extensor mechanism interruption or vascular damage. Quadriceps turndown provides to a wide joint exposure, using a “V-Y” plasty of the quadriceps tendon. Tibial tubercle osteotomy (TTO) consists in the osteotomy of a bone fragment containing anterior tibial tubercle and patellar tendon, and subsequent eversion. Both quadriceps turndown both TTO are challenging procedures, and the choice of this kind of exposure must be weighed according to proper indications and potential pitfalls.

Problems and solutions of the extensor mechanism

Disruption of the extensor mechanism in a total knee patient is a devastating complication. This article focuses on prevalence, diagnosis, and treatment of a quadriceps tendon tear, patellar fracture, and patellar tendon rupture. Non-surgical management remains the standard of care in patients with a limited extensor lag. Reconstruction with an augment in more severe cases requires rigid fixation, coverage with host tissue, tensioning the augment material, and prolonged postoperative bracing in full extension. Patients continue to exhibit a high rate of complications following this uncommon and dire problem, so understanding the surgical risks and options is crucial.

Patellar tendon re-rupture on the opposite end of the previous site of surgical repair.

We describe a rare case of a patellar tendon “re-rupture” at the opposite end of a previous proximal tendon repair. A 32-year-old male with a history of surgically repaired right proximal patellar tendon rupture presented with an acute non-traumatic right knee pain and instability during sports. Magnetic resonance imaging confirmed a complete rupture of his distal patellar tendon at the tibial tuberosity. The patellar tendon was repaired using two 5.5 mm BioCorkscrews (Arthrex) inserted into the tibial tuberosity; the tendon was stitched with the No. 2 fiberwires using Krackow technique. As the patellar tendon was degenerative, the repair was augmented with a semitendinosus tendon harvested using an open tendon stripper, leaving the distal attachment intact. At 2.6 years followup he had mild anterior knee pain, range of motion 0-130° and was able to squat. MRI scan done at followup revealed good healing of repaired patellar tendon.

Massive Patellar Tendon Ossification: Excision and Simultaneous Total Knee Replacement

Tendon ossification has a multifactorial aetiology. We present a case of a massive ossification within the substance of patellar tendon. A 79-years-old male who had a previous history of patellar tendon rupture and its surgical repair. He gradually developed a large bony mass within the patellar tendon and progressive symptoms of arthritis in the knee joint. The patient underwent a total knee replacement along with simultaneous excision of the entire bony lump and primary repair of the patellar tendon. The knee was mobilised gradually after surgery and achieved satisfactory range of motion, function and alleviation of symptoms without any complication.

Proximal Patellar Tendon Repair: Internal Brace Technique With Unicortical Buttons and Suture Tape

Patellar tendon ruptures may be considerably limiting, especially in younger and highly active patients. These injuries ultimately result in a complete inability to maintain extension of the knee, thereby placing strict impediment on physical activity. As a result, a durable repair construct via surgery is necessary to allow patients to return to their preinjury activity level. Because of the inherent difficulty in maintaining patellar tendon position after repair, and to avoid failure of the tendon healing to the patella, we recommend using an internal brace construct. The construct uses bone tunnels in the patella and also cortical buttons on the tibia with suture tape whipstitched through the tendon. We feel that this provides an enhanced fixation construct. The purpose of this Technical Note is to describe our preferred method for proximal patellar tendon repair via an internal brace construct with unicortical buttons and suture tape.

Surgical Treatment for Failure of Repair of Patellar and Quadriceps Tendon Rupture With Ipsilateral Hamstring Tendon Graft.

Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patellar tunnel openings with sutures. The details of the technique are fully described. Autologous ipsilateral hamstring tendon grafts provide a secure sound means to manage these challenging injuries.

Patellar Tendinopathy and Potential Risk Factors: An International Database of Cases and Controls.

Numerous risk factors have been identified for patellar tendinopathy (PT), often in small population studies. The aim was to use an international online questionnaire to generate a large database and identify significant risk factors. Case-control study. Private practice and sporting teams recruited from England, Spain, and Italy with the questionnaire available in all 3 languages (equivalence between online and self-administration shown previously). All data were anonymized and password protected. Eight hundred twenty-five data sets collected between January 2012 and May 2014. A total of 23.4% of participants had clinically diagnosed PT. A comparison between these participants and participants without PT was made. Association between the presence of PT and risk factors. Eight risk factors were included in the analysis based on a purposeful selection procedure: sex, hours of training, hamstring flexibility, previous patellar tendon rupture, previous knee injury, current/previous back pain, family history, and age. Four were found to have statistically significant odds ratios: female sex [0.70, 95% confidence interval (CI), 0.49-1.00, P = 0.05], hours of training (>20 hours 8.94, 95% CI, 4.68-17.08, P < 0.01), previous knee injury (2.10, 95% CI, 1.45-3.04, P < 0.01), and flexible hamstrings (0.61, 95% CI, 0.38-0.97, P = 0.04). There was a trend toward association for back pain (1.45, 95% CI, 0.99-2.14, P = 0.06) and a family history of tendon problems (1.51, 95% CI, 0.96-2.37, P = 0.08). Risk factors have been identified that are potentially modifiable to inform prevention and rehabilitation programs; future research is required to establish causal relationships. Identified risk factors require mechanistic investigation as they are not currently recognized in the literature.

A Rare Case of Bilateral Patellar Tendon Rupture Associated with Anabolic Androgenic Steroids Use

Bilateral rupture of the patellar tendon is a very rare injury in healthy individuals. Some pathologic conditions or repeated local steroid injections can predispose to the occurrence of this lesion. The effect of oral medication on the tendon remains controversial. Anabolic androgenic steroids (AAS) have a powerful effect on the musculoskeletal system, despite the risk of some adverse consequences. The use of these drugs has been associated with tendon rupture, however, only few cases of tendon injury associated with AAS have been reported, and specific pathophysiological mechanisms are not well known. We present a case of a healthy middle-aged male, recreational bodybuilder, who presented to our institution with the diagnosis of bilateral patellar tendon rupture. His single risk factor to this uncommon injury was the use of AAS. The aim of this case report is to raise awareness for the association between the use of AAS and tendon rupture.

Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: surgical technique.

Patellar tendon chronic ruptures are more debated to manage that acute injuries as the patella tends to retract proximally (after 2 weeks), and surrounding soft tissues may make the repair more complicate. We propose a novel technique in which the patellar tendon is reconstructed using ipsilateral hamstring tendons. This surgical procedure implies to drill a single tunnel through the patella and another through the tibia to reduce the risk of bony breakage. In addition, the tendon is secured to the bone, at the tunnel exit points, by periostium sutures without requiring any additional surgery for hardware removal. We assessed 19 patients (16 men and 3 women) who underwent PT reconstruction at an average of 5.8 years (range, 4 to 7.8 years, SD: 3.5) from the index surgery. The mean age at surgery was 46 ± 9.2 years (range, 38-59 years). All patients had a complete tear of the patellar tendon. The main indication for this procedure is the reconstruction of the PT in patients with chronic rupture (>6 weeks) in which the tendon gap is greater than 2 centimeters and the scar tissues and degenerated tendon ends do not allow to juxtapose the tendon stumps to each other. Level IV.

Open patellar tendon rupture: a case report

Open patellar tendon rupture: a case report

Proximal Tibial Osteotomy for Progressive Genu Recurvatum Deformity after Surgical Treatment of Patella Tendon Rupture at the Tibial Tuberosity : A Case Report

Proximal Tibial Osteotomy for Progressive Genu Recurvatum Deformity after Surgical Treatment of Patella Tendon Rupture at the Tibial Tuberosity : A Case Report

Total bilateral ruptures of the knee extensor apparatus

ObjectiveBilateral extensor tendon ruptures of the knee are rare and have only been published in the form of case reports or small series. MethodsSeven patients corresponding to 14 extensor tendon ruptures of the knee were evaluated by the same examiner after a minimum one year post-surgery. Clinical and radiographic evaluations were performed; for statistical analysis, the level of significance was set at 0.05. ResultsThe most common injury was patellar tendon rupture (n=9; 64.29%) followed by quadriceps tendon rupture (n=5, 35.71%). The intrasubstance was the most affected location (57.15%), followed by the myotendinous junction (21.43%) and the patellar bone insertions (21.43%). Quadriceps tendon ruptures were more prevalent in patients older than 50 years, while patellar tendon ruptures tended to occur in younger individuals. All but one patient had recognized risk factors for tendinous degeneration and rupture: 75% of the cases suffered from diseases, 50% had history of drug use and/or abuse, and 37.5% had both disease and drug use history. Mean attained values for flexion ROM were 124.64°±9.43 (110–140°) and 89.57±6.02 (78–94) for Kujala score. More than half of the patients complained of residual pain and quadriceps muscular weakness. Mean age was younger in the individuals who complained of residual pain. ConclusionBilateral tendon ruptures of the knee extensor apparatus ruptures are rare and serious injuries, mostly associated with risk factors. Early surgical repair and intensive rehabilitation program for bilateral extensor tendon ruptures of the knee may warrant satisfactory functional outcomes in the medium to long term, despite non-negligible levels of residual pain, quadriceps muscle weakness, and atrophy.

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

IntroductionLatest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methodsIn this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9–36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded.One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. ConclusionWhen proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients

ObjectiveWe aimed to evaluate the clinical outcomes after surgical repair of patellar tendon rupture (PTR) and compare the evolution of 2 types of rupture (acute and chronic) after the same rehabilitation protocol. MethodsThis was a prospective cohort study of patients with PTR treated between January 2006 and January 2014 in the department of trauma surgery, Ibn Rochd university hospital, Casablanca. ResultsWe evaluated 25 patients (21 men) after a median follow-up of 75 months (range 29–120). The mean age was 34.7±8.59 years. Overall, 17 patients had acute rupture and 8 chronic rupture. Fifteen healthy volunteers (13 men) were recruited as a control group. Mean Knee Society Score (KSS) knee score was significantly higher after than before surgery (82.28±12.297 vs 20.64±7.6; P<0.0001) as was KSS function score (88.40±17.483 vs 23.40±8.98; P<0.0001). Pain measured on a visual analog scale was significantly lower after than before surgery (1.96±1.24 vs 6.60±1.26; P<0.0001). ROM and KSS knee and function scores were significantly lower on the operated than non-operated side after surgery. For both types of PTR, only knee extensor muscle strength was significantly lower on the operated than non-operated side and as compared with healthy volunteer knees. ConclusionsSurgical repair of PTR with reinforcement and an early rehabilitation program demonstrate good results after a long follow-up. However, chronic PTR may need longer or a different rehabilitation protocol of the knee-extensor apparatus.

Chronic Patellar Tendon Rupture: A Case Report with Associated Imaging

Chronic Patellar Tendon Rupture: A Case Report with Associated Imaging