Repair Of Patellar Tendon Rupture Research Articles

Senior Military Rank Is Associated With Higher Rates of Return to Running and Unrestricted Activity Among Military Servicemembers After Surgical Repair of Patellar Tendon Rupture at 1-Year Follow-up

To evaluate 1-year outcomes in active-duty servicemembers who underwent patellar tendon rupture repair and to identify baseline variables associated with return to activity. We performed a retrospective review of all active-duty servicemembers undergoing primary patellar tendon rupture repair between 2009 and 2014. All patients had a minimum 12-month follow-up. Demographic variables were recorded, as well as ability to return to impact activities and remain on active-duty status. Rates of recurrent rupture and revision surgery were identified. Univariate analysis was performed to assess relations between outcomes and baseline variables. A total of 123 patients met the inclusion criteria (average age, 33.5 ± 6.6 years; 99% male patients) with a mean follow-up period of 4.3 ± 2.2 years. Whereas 67.4% of patients returned to running at an average of 8.3 months from index surgery, only 42.4% of patients resumed unrestricted occupational function. Higher rates of return to running were observed among patients with senior military rank (P= .046). Senior military rank was also associated with a higher rate of return to unrestricted active-duty status (P= .006). Logistic regression analysis showed an association between postoperative pain (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.56-0.84; P < .001) and return to running, between postoperative pain (OR, 0.77; 95% CI, 0.60-0.98; P= .033) and return to active duty, and between rank (OR, 2.06; 95% CI, 1.04-4.07; P= .037) and return to active duty. Patients who sustained injuries during deployment had a higher rate of recurrent rupture (26.1% vs 9.3%, P= .028). At 1-year follow-up, approximately two-thirds of military servicemembers undergoing primary patellar tendon repair had returned to running after surgery, whereas fewer than one-half returned to full military duty. Younger age and more senior military rank were associated with higher rates of return to running. Additionally, servicemembers of higher rank, particularly officers, had statistically higher rates of return to unrestricted activity. Level IV, therapeutic case series.

Biomechanical Analysis of Patellar Tendon Repair With Knotless Suture Anchor Tape Versus Transosseous Suture

Background:Patellar tendon ruptures have routinely been repaired with transosseous suture tunnels. The use of knotless suture anchors for repair has been suggested as an alternative.Purpose:To compare the load to failure and gap formation of patellar tendon repair at the inferior pole of the patella with knotless suture anchor tape versus transosseous sutures. A secondary objective was to investigate whether either technique shows an association between bone density and load to failure.Study Design:Controlled laboratory study.Methods:A total of 20 human tibias with attached patellar and quadriceps tendons were sharply incised at the bone-tendon junction at the inferior pole of the patella. A total of 10 tendons were repaired using 2 knotless suture anchors in the inferior pole of the patella and a single suture tape with 2 core sutures. The other 10 tendons were repaired using No. 2 suture passed through 3 transosseous tunnels. A distracting force was then applied through the suture in the quadriceps tendon. Gap distance through load cycling at the repair site and maximum load at repair failure were then measured. Bone density was measured using computed tomography scanning.Results:No difference was found in the mean load to failure of knotless patellar tendon repair versus transosseous suture repair (367.6 ± 112.2 vs 433.9 ± 99 N, respectively; P = .12). After 250 cycles, the mean repair site gap distance was 0.85 ± 0.45 mm for the knotless patellar tendon repair versus 2.94 ± 2.03 mm for the transosseous suture repair (P = .03). A small correlation, although not statistically significant, was found between bone density and load to failure for the knotless tape repair (R 2 = 0.228; P = .66). No correlation was found between bone density and load to failure for the transosseous repair (R 2 = 0.086; P = .83).Conclusion:Suture tape repair with knotless anchors for repair of patellar tendon rupture has comparable load to failure with less gap formation than transosseous suture repair. There is a small correlation between bone density and failure load for knotless anchor repair, which may benefit from further investigation.Clinical Relevance:Using knotless suture anchors for patellar tendon rupture repair would allow for a smaller incision, less dissection, and likely shorter operating time.

Return to sport after early surgical repair of acute patellar tendon ruptures

IntroductionPatellar tendon ruptures make up about 5% of all extensor mechanism injuries. They mainly occur in young, athletic men who have contributing risk factors such as chronic tendinopathy. The aim of this study was to evaluate the return to sport after repair of an acute patellar tendon rupture. We hypothesized that surgical repair yields good functional outcomes with a high rate of return to competitive sports in patients treated with the same surgical technique. MethodsThis retrospective study involved 23 cases of patellar tendon rupture in 20 patients (2 women, 18 men). The average age was 42.0±13.8 years (24–68). Eighteen ruptures occurred at the patellar attachment and five were mid-substance. Either transosseous reattachment or direct suture repair was carried out within 21 days; all tendons were augmented with a non-metallic tibiopatellar suture. At the final assessment, a clinical examination was carried out (extensor mechanism testing and range of motion) with collection of functional scores (pain, VISA-P, Lysholm and satisfaction), date of return to sport and final radiographs. ResultsAt a mean follow-up of 47.7 months (15–120), there were no cases of significant knee stiffness. Seventeen patients (94.4%) had returned to sport, 15 at their pre-injury level (83%). The mean time before running could be restarted was 9 months (6–15 months) and 17 months for sports at the same pre-injury level (8–18 months). The mean VISA score and the mean Lysholm score were 85.5 (62–99) and 67.3 (35–97) respectively; 85% of patients were satisfied or very satisfied. The prognosis was worse when the patient was older than 40 and had a BMI above 25. Early surgical repair of patellar tendon rupture yields good functional outcomes with return to sport possible at high levels. Level of evidenceIV, Retrospective cohort study.

Trans-osseous versus Anchor Repair of Acute Patellar Tendon Ruptures

Objectives:Patellar tendon ruptures are relatively uncommon injuries. They require prompt diagnosis and surgical repair to restore the extensor mechanism of the knee. The gold standard procedure is a suture repair of the tendon, passed through trans-osseous tunnels, and tying of the sutures on the superior pole of the patella. Suture anchors have gained popularity with a recent cadaveric study demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads. We present the largest series of patellar tendon repairs and compare the clinical outcomes and complications of trans-osseous (TO) and anchor (A) repair types.Methods:All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury, between 2007 and 2016, were retrospectively reviewed. Surgeries were performed at a multi-surgeon (114 surgeons), multi-center (13 centers) community-based integrated health care system. Patients with prior knee surgery, use of graft, patellar debridement for tendonitis, inferior pole avulsion fracture, concurrent knee surgery with other procedures were excluded. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded.Results:361 patients (374 knees) met our inclusion criteria. 13 had bilateral repairs during our study period and an additional 8 had a contralateral repair prior to our study period, for a bilateral incidence at 5.8%. The average age was 39.8 years (9 to 86 years). There were 341 males (94.5%). The most common mechanism of injury was basketball (47%), fall (19.5%), football (5.0%), and soccer (4.8%). Average time from injury to surgery was 6.3 days (range: 1- 45 days). There were 321 TO and 53 A repairs. There was no significant difference in the mean age (P=0.27), gender (P=0.79), tourniquet time (P=0.93), or BMI (P=0.78) between the two groups. There was a significant difference in re-rupture between (24 of 321) TO (7.5%) and (0 of 53) A (0%) (P=0.034). Using logistic regression, we found that TO had 3.244 times the odds of re-operation as those with A (95% CI: 0.757, 13.895. p-value: 0.1129) but did not reach signficance. The infection rate was 7.5% for A and 1.6% for TO (P= 0.160). There was no difference in time to release from medical care, 18.4 weeks for and 17.1 weeks (P=0.92).Conclusion:Compared to Anchors, primary repair of patellar tendon ruptures with trans-osseous repair had a significantly higher re-rupture rate, but there was no difference in re-operation rate, infection, or release from medical care.

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.

Biomechanical Evaluation of Patellar Tendon Repair Techniques: Comparison of Double Krackow Stitch with and without Cerclage Augmentation

The purpose of this study was to evaluate two different repair techniques for the primary repair of patellar tendon ruptures. Using a cadaveric model, we biomechanically compared a double Krackow stitch with, and without cerclage augmentation. The specimens were tested at loads comparable to those likely to be encountered during an early rehabilitation program (approximately 40 Newtons) and for maximal mechanical parameters. The force at failure of the augmented repairs was 329 ± 89 Newtons (N), while the non-augmented repairs failed at 278 ± 87 N. However, the force required to produce significant gapping at the repair site was not significantly different between both repair techniques. Additionally, there was no significant difference between the mean stiffness of the repairs in both groups within the loading range from 10-100N. However, as expected, at loads greater than 100 N the cerclage augmented repairs were significantly stiffer. Most notably, there was no gap formation in any of the constructs tested at forces (40 N) comparable to those seen during an early passive extension and active flexion program. These data suggest that it may be possible to achieve the benefits of an early rehabilitation program without augmentation of the repair, and thus avoid the potential complications arising from this additional material.

Functional outcomes after surgical repair of acute and chronic patellar tendon ruptures

Patellar tendon rupture is an uncommon injury requiring immediate repair to restablish knee extensor continuity and to allow early motion. The aim of this study was to evaluate the clinical outcomes of surgical repair of patellar tendon rupture and compare the evolution of two groups (acute and chronic ruptures). This was a retrospective study of 25 cases operated for patellar tendon rupture and followed in our department. Functional knee evaluation and quality of life were performed. There were 21 men and 4 women. The average age was 33.60 years. The ruptures were fresh in 17 cases and neglected in 8 cases. There was a significant difference between the range of motion, IKS knee and IKS function when the injured leg was compared to the non-injured leg. In comparison between group with acute rupture and the other with chronic rupture, no significant difference was found in IKS knee, IKS function, SF 12 PCS, SF 12 MCS, pain score and satisfaction. Only the ROM of the knee was significantly different between two groups. Patellar tendon ruptures are usually complete and long-term follow-up results indicate excellent function with early repairs. Direct repair of the rupture with cerclage stabilization demonstrates good intermediate to long-term results.

Suture Anchor Repair of Patellar Tendon Rupture after Total Knee Arthroplasty

Extensor mechanism disruption after total knee arthroplasty (TKA) is a complex problem that often requires surgical repair for functional deficits. We present a brief technical note on suture anchor fixation of a patellar tendon rupture after TKA. A surgical technique and literature review follows. Although suture anchor fixation is well described for tendinous repairs in other areas of orthopedic surgery, no study has discussed the use of suture anchors in patellar tendon repair after TKA. The technique must be evaluated in more patients with longer follow-up before adoption.

Repair of Patellar Tendon Rupture Using Suture Anchors

Acute isolated rupture of the patellar tendon traditionally has been repaired via transpatellar suture tunnels. This retrospective study evaluated the demographics and epidemiology of this injury as well as the effectiveness and complication rates of our suture anchor technique. Between 1993 and 2005, a total of 82 cases of patellar tendon disruption in 71 patients were repaired. Fourteen cases involved basic primary repair with suture anchors of an acute isolated rupture of the patellar tendon and had an average follow-up of 29 months (range: 3-112 months). There were 3 (21%) failures of repair. The remaining 11 patients had excellent range of motion and strength and returned to their preoperative level of function. These results are comparable with other reports in the literature. The suture anchor technique thus represents a viable option for repair of patellar tendon ruptures and should be investigated further with a randomized, controlled trial.

Repair of Patellar Tendon Rupture With Suture Anchors

Repair of a ruptured patellar tendon is usually performed with the use of sutures that are passed through intraosseous tunnels within the patella. However, a number of caveats pertain to this method. The Beath pin may penetrate the articular surface or may unduly injure the quadriceps through multiple passes. The already injured patellar tendon may be overly shortened after debridement and insertion into bony tunnels, and loosening through the tunnels may occur. Obliquely oriented bony tunnels may cause abnormal patellar tilt, leading to uneven force distribution. This technical note reports the details of an alternative repair with 3 suture anchors that is incorporated into a 6-stranded Krackow technique, with additional mattress sutures as needed. Because of the low-profile nature of the anchors, this technique more accurately re-creates the footprint at the inferior pole of the patella and avoids articular cartilage penetration and injury to the surrounding soft tissue. The possibility of loosening through bony tunnels or creation of abnormal stresses is eliminated. A smaller incision is used, and operative (tourniquet) time is diminished. Although pullout of the anchors may be a logical concern, previous studies have suggested that this construct is more than sufficient to withstand the forces to which it is subjected.

The Use of Suture Anchors in Repair of the Ruptured Patellar Tendon

Background Rupture of the patellar tendon is a disabling injury that usually requires surgical treatment. The standard method of repair involves placing suture loops through transpatellar tunnels. The use of suture anchors in patellar tendon repair has not been previously described. Hypothesis No difference exists in the amount of gap formation during cyclic loading or in ultimate load-to-failure strength between repairs performed with anchors and those performed with 2 types of transpatellar sutures. Study Design Controlled laboratory study. Methods Six matched pairs of cadaveric knees were tested in a custom biomechanical apparatus based on an established model. Repairs were performed using either suture anchors with No. 2 FiberWire or transpatellar suture tunnels using 2 different types of suture—No. 5 Ethibond and No. 2 FiberWire. Gap formation across the repair site during 250 cycles of extension as well as ramp-up load to failure were measured for each repair. Results The mean total gap formation across the repair site at 250 cycles was 4.1 ± 1.9 mm for the suture anchor group, 6.7 ± 1.8 mm for the FiberWire tunnel group, and 8.5 ± 2.7 mm for the Ethibond tunnel group. Mean load to failure was 779 ± 183 N, 730 ± 83 N, and 763 ± 231 N, respectively. Conclusion Significantly less gap formation throughout 250 cycles (P = .009) and no difference in load to failure occurred with patellar tendon repairs performed with suture anchors as compared with repairs performed with transpatellar tunnels. Clinical Relevance The newly described method, using suture anchors for repair of patellar tendon ruptures, may be clinically equal or superior to the established method of using transpatellar tunnels.

Use of the Leeds–Keio prosthetic ligament for repair of patellar tendon rupture after total knee arthroplasty

We describe a technique for repair of the patellar tendon rupture after total knee arthroplasty (TKA), using the Leeds–Keio (L-K) prosthetic ligament. Two patients were followed for a mean of 38 months. Knee extension power and improved function were obtained in both cases. Use of the L-K ligament is a treatment option for repair of patellar tendon rupture following TKA.

Primary repair of patellar tendon rupture without augmentation.

Repair of patellar tendon ruptures has often relied on cerclage augmentation and prolonged immobilization in extension. We are reporting our experience with avulsion injuries as well as midsubstance ruptures, both treated with primary repair without augmentation, allowing early mobilization in the athlete less than 40 years of age. Repairs were performed to allow knee flexion to more than 60 degrees. Rehabilitation was performed with heel slides, allowing flexion to 45 degrees for the first 3 weeks, increasing to 90 degrees at 3 to 6 weeks, and thereafter without restriction. An accelerated weightbearing and muscle strengthening program was adopted. At a mean follow-up of 2.6 years (range, 20 to 61 months), 12 patients had returned to their previous levels of activity. No loss of extension or extensor lag was noted; mean flexion loss was 5 degrees. Patellofemoral symptoms and signs were present in five patients, but activity was limited in only two. Mean peak torque at 60 deg/sec was 92% (range, 73% to 105%). Mean Lysholm score was 94 +/- 2.5 points. Primary repair with immediate, protected range of motion resulted in uniformly excellent results and obviated the need for manipulation or subsequent hardware removal.

Repair of patellar tendon disruptions without hardware.

Acute repair of disruptions of the knee extensor mechanism is indicated to reestablish extensor continuity and allow for early motion. This study reviews the results of acute primary repair of patellar tendon ruptures augmented by a nonabsorbable polyester tape (Mersilene; Ethicon, Inc.) followed by immediate mobilization. Twenty-four patients with disruptions of their patellar tendons were treated using the described technique. The ruptured tendon was initially approximated using an end-to-end suture repair with no. 5 Ticron suture in a whipstitch manner. An O Vicryl suture was used to approximate the free tendon edges. A 5-mm Mersilene tape was then used in a cerclage manner to augment and protect the repair. Postsurgery, passive range of motion (ROM) was begun immediately in the knees with isolated injury or in those patients whose concomitant injuries would allow for early motion. Using clinical and radiographic criteria, follow-up evaluations of 19 patients were performed at an average of 22.4 months. In patients with isolated injuries, active ROM was from 0 degrees extension to 132 degrees flexion (contralateral knee 0-135 degrees). Two patients had prominent knots: in one, the knots were painful and were removed surgically. Six patients developed patellofemoral chondrosis. Five patients had the Mersilene tape tied with the knee in full extension, and all developed patellofemoral pain. The other repairs were done with the knee flexed to 90 degrees before tying; one patient in this group developed patellofemoral symptoms. All patients with isolated injuries have returned to employment. There were no reruptures or infections.(ABSTRACT TRUNCATED AT 250 WORDS)