Treatment Of Patellar Tendon Rupture Research Articles

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.

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.

Bilateral patellar tendon rupture: a case report

&lt;p&gt;Bilateral patellar tendon rupture is a rare injury, usually associated with systemic disease or chronic medication side effect. Early diagnosis and prompt surgical repair are essential to achieve good functional outcomes. The authors report a case of a 44-year-old male with history of multiple urinary tract infection treated with fluoroquinolones who sustained spontaneous simultaneous bilateral patellar tendon rupture. Patient underwent bilateral transosseus tendon repair with autologous semitendinosus augmentation. Nine months after surgery, the patient was able to walk without pain and unassisted, had a normal range of motion in both knees and performed his daily activities without limitation. Surgical treatment of patellar tendon rupture is recommended to allow prevention of extensor mechanism disfunction sequelae. Transosseus tendon repair with autologous semitendinosus augment plasty is a valid surgical technique for treatment of this pathology with biomechanical and literature support.&lt;/p&gt;

An Isolated Transosseous Flexible Suture Frame in the Treatment of Patellar Tendon Rupture Provides Adequate Mechanical Resistance.

Acute patellar tendon ruptures are frequently observed in patients with metabolic comorbidities, and the benchmark treatment is surgical repair. It is desirable not to harm an already fragile biologic environment with sutures and hardware. We aimed to compare the mechanical requirements of an isolated, flexible, high-strength nonabsorbable transosseous suture frame with that of the Krackow suture technique. A total of 12 cadaveric pieces were randomized into two groups: the isolated flexible frame group (n = 6) and the standard Krackow fixation group (n = 6). A traumatic rupture of the patellar tendon was performed, and a transosseous displacement sensor was installed on a validated biomechanical system. Gap formation was measured during 50 cycles of flexion and extension with traction on the quadriceps (250 N). Subsequently, specimens underwent progressive loading in a fixed flexion position until failure occurred. The data were analyzed using nonparametric statistical tools with a significance level of 5%. The isolated frame group had a smaller gap formation (1.7 mm) than the Krackow group (3.4 mm; P = 0.01). No significant difference existed in the median failure end points of the two groups (676 and 530 N, respectively; P = 0.11). Patellar tendon repair using an isolated, transosseous, flexible, suture frame outperformed using the traditional Krakow repair technique in gap formation. Further studies are needed to determine if this will result in better functional outcomes or fewer clinical failures. Level IV, experimental case series.

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)

Patellar tendon ruptures : Internal bracing and augmentation technique

To report asurgical technique for the treatment of patellar tendon ruptures augmented with an internal brace suture tape. Acute patellar tendon ruptures, fractures of the distal patellar pole, chronic insufficiency of the patellar tendon or revision surgery for failed repairs. Severe damage to the surrounding soft tissue. Local infection. Life-threatening conditions. Direct longitudinal anterior approach to the patellar tendon. Two parallel transosseous bone tunnels are drilled in the patella and tibial tuberosity with a2.4 mm drill bit. Two separate FiberTapes® (Arthrex, Naples, FL; USA) are shuttled through the proximal and distal bone tunnels around the tendon in "X" and "O"type configuration. Patellar height is reestablished under fluoroscopic control and both FiberTapes are tied down. Both tendon ends are debrided and readapted with absorbable sutures. Passive motion exercise to 90° of flexion from day1. Partial load to 20 kg of body weight with knee in locked full extension brace during first 2weeks. Isometric exercises from week3. Passive flexion to 110° from week4 (adapted to pain). Free active range of motion and weight bearing from week7. In more than 10 years of clinical application, positive results were continuously found in acute as well as chronic patellar tendon ruptures. These results are consistent with those in the current literature.

Patellar tendon rupture after total knee arthroplasty: semitendinosus tendon graft augmentation with direct repair

Introduction Rupture of the patellar tendon after total knee arthroplasty is an infrequent but serious complication. Several methods for treating this catastrophic complication have been described. The purpose of this article was to evaluate the results of semitendinosus graft augmentation with direct repair in the treatment of patellar tendon rupture after total knee arthroplasty.

Biomechanical Properties of Suture Anchor Repair Compared With Transosseous Sutures in Patellar Tendon Ruptures

Background: Ruptures of the patellar tendon are debilitating injuries requiring surgical repair. Reliable data about the most appropriate suture technique and suture material are missing. The standard procedure consists of refixing the tendon with sutures in transpatellar tunnels, sometimes combined with augmentation. Hypothesis: Suture anchors provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared with transosseous suture repair. Study Design: Controlled laboratory study. Methods: A total of 30 human cadaveric patellar tendons underwent tenotomy followed by repair with 5.5-mm titanium suture anchors, 5.5-mm resorbable hydroxyapatite suture anchors, or transpatellar suture tunnels with No. 2 Ultrabraid and the Krackow whipstitch technique. Biomechanical analysis included pretensioning the constructs at 20 N for 30 seconds and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed. Results: Compared with transosseous sutures, tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (P < .05) and resisted significantly higher ultimate failure loads (P < .05). Common failure mode was pullout of the eyelet within the suture anchor in the hydroxyapatite anchor group and rupture of the suture in the titanium anchor group and—at lower load to failure—in the transosseous group. Conclusion: Patellar tendon repair with suture anchors yields significantly better biomechanical results than repair with the commonly applied transosseous sutures. Clinical Relevance: These findings may be of relevance for future clinical treatment of patellar tendon ruptures. Randomized controlled clinical trials comparing suture anchors to transosseous suture repair are desirable.

Extensor Mechanism Ruptures

The extensor mechanism of the knee consists of the quadriceps muscle and tendon, the patella, the patellar tendon, and the tibial tubercle. Disruption of any of these can lead to an extensor mechanism rupture and render an otherwise perfectly good total knee replacement (TKR) useless. Quadriceps tears associated with TKR are difficult to treat and associated with a poorer prognosis than in the native knee. Transosseous sutures tied over the distal pole of the patella are recommended. Patella fractures may heal in continuity or may involve a disruption of the extensor mechanism. The blood supply may have been compromised during TKR, so healing may be delayed. The patella component may be loose and need to be removed or revised. Patellar tendon ruptures are the most common and serious form of extensor mechanism rupture. Prevention is more effective than treatment. Careful exposure during revision surgery includes anticipating the need for a quadriceps snip, pinning the tubercle to avoid avulsion, and preserving the fat pad during primary surgery. Treatment of patellar tendon ruptures is challenging. Primary repair may succeed in early intervention, but in established rupture, allograft reconstruction is often necessary. Achilles tendon allograft is preferred. The calcaneus fragment is embedded into the proximal tibia as a new tubercle, and the tendon is sutured into the remaining extensor mechanism. The repair is then protected using a cable loop from the superior pole of the patella to a drill hole in the upper tibia.

Repair of ruptured quadriceps tendon with Leeds–Keio ligament following revision knee surgery

We describe the use of the Leeds-Keio ligament to reconstruct a neglected quadriceps tendon rupture following revision knee arthroplasty. The Leeds-Keio ligament has been used in the treatment of patellar tendon ruptures complicating primary knee arthroplasty with good result--but may, as this report shows, also be successfully applied to address deficiencies of the quadriceps tendon in the revision setting, with continued good function for 2 years.