Bilateral patellar tendon repair with suture bridge augmentation: A case report

Bilateral simultaneous patellar tendon rupture is a rare entity. Most case studies in the literature have been reported in patients with an underlying systemic condition, i.e. systemic lupus erythematosus, rheumatoid arthritis, or associated with a history of steroid injections about the infrapatellar tendon. A recent case report treated at Dwight David Eisenhower Army Medical Center without a predisposing underlying systemic condition or history of injection is presented. Our patient is the youngest to be reported in the literature. The literature is reviewed on this subject, and the mechanism of injury presented.

IntroductionIsolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making.MethodsThe systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies.ResultsThirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI, p < 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment).ConclusionCombined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.

Rupturas bilaterais simultâneas dos tendões patelares

Bilateral patellar tendon (BPT) rupture is an exceedingly rare cause of extensor mechanism failure with many patients having predisposing factors such as systemic disease, steroid, or antibiotic use that increase the risk. Patients may present with an inability to extend the knee, diffuse pain and swelling, and a high riding patella on lateral radiographs. We present a case of a young man without predisposing factors or systemic disease who experienced a BPT rupture while playing sports.

The purpose of this study was to evaluate whether increased anteroposterior (AP) thickness of the proximal patellar tendon at preseason evaluation is predictive of symptomatic patellar tendinopathy and associated sequelae. Thirty-one male National Collegiate Athletic Association (NCAA) Division I basketball players voluntarily participated in this study (n = 52 tendons from 27 athletes after application of exclusion criteria, with evaluation at preseason, midseason, and postseason time points). At each time point, Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) scores, patellar tendon tenderness, patellar tendon AP thickness, and the presence of a proximal patellar tendon hypoechoic region were evaluated. Measurement of patellar tendon AP thickness and the identification of hypoechoic regions were performed using a portable ultrasound device. Outcome measures included a proximal patellar tendon hypoechoic region, a trip to the training room (TTR), time-loss symptomatic patellar tendinopathy (TLPT), and patellar tendon rupture. Covariates evaluated in the multivariable regression model included body mass index and a patient-reported history of patellar tendinopathy (α = 0.05). The mean preseason tendon thickness was 4.78 ± 1.22 mm. Nine (17.3%) of the tendons were symptomatic to the point of requiring a TTR. Preseason tendon thickness was associated with increased odds of a TTR (adjusted odds ratio [aOR] = 3.68 [95% confidence interval (CI) = 1.73 to 7.81]; p < 0.01). The predicted probability of a TTR was 86.0% with a preseason tendon thickness of 8 mm versus 3.4% with a preseason tendon thickness of 4 mm. Preseason tendon thickness was also predictive of TLPT (aOR = 1.96 [95% CI = 1.03 to 3.71]; p = 0.04). Preseason VISA-P scores were not predictive of a TTR (p = 0.66) or TLPT (p = 0.60). Increased patellar tendon thickness on preseason ultrasound is predictive of symptomatic patellar tendinopathy and associated sequelae during an NCAA Division I basketball season. Ultrasound identification of at-risk individuals may allow triage toward additional physical therapy and activity modification for these athletes to prevent progression to irreversible patellar tendon disease. These data support the use of ultrasound as a screening tool for elite jumping athletes. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Jumper's Knees Case Report - Neuromuscular Rehabilitation of a Basketball Player with Bilateral Patellar Tendon Ruptures

Bilateral patellar tendon rupture in active duty service member

Patellar Tendon (PT) rupture is an uncommon injury of the knee extensors. Majority of the PT ruptures occur at the insertion site, on the inferior pole of the patella as an avulsion injury, mostly in males of &lt;40 years of age and involving sports persons or accidental cases. A case series of 10 cases of neglected PT rupture were managed with primary repair along with augmentation with semitendinosus and gracilis (Hamstring tendons) graft. Patient follow-up was done postoperatively at 2nd week, 6th week, 3 months, 6 months, and then yearly. A knee brace was given to the patient postoperatively to immobilise the knee for two weeks. Static quadriceps strengthening exercises were started from postoperative day two. Assisted quadriceps strengthening exercises were allowed after two weeks postoperatively. Active quadriceps strengthening exercises were initiated after four weeks postoperatively. Partial weight bearing was allowed after four weeks and full weight bearing was allowed after eight weeks postoperatively. Postoperatively functional scoring was done using the International Knee Documentation Committee (IKDC) and Lysholm scores, simultaneously checking the knee range of motion, Insaal-Salvati ratio and quadriceps girth. Total of 8 males and 2 females were present with the mean age 43.9 years ranging from 38-53 years. The average period of follow-up was 25.5 months (range 12-39 months). Results were excellent with faster recovery and regain their normal physically active life around 8 months after reconstruction.

Musculoskeletal soft tissue repair is often a slow process that may be complicated by aging, thus we investigated the mitogenic response of young and old rat patellar tendon (PT) explants to platelet-derived growth factor-AB (PDGF-AB). Bilateral PT explants from young (4 months) and old (29 or 36 months) rats of two strains (Fisher 344 and Fisher-Brown-Norway) were cultured for 72 h in platelet-poor horse serum in the presence or absence of 100 ng/ml recombinant human PDGF-AB. The explants were radiolabelled with [3H]-TdR for the final 24 h in culture. Tendon cellularity and DNA synthesis data were analyzed by multiple factor ANOVA (age, strain, and side), Mann-Whitney t-test (cellularity and DNA synthesis), and a sign test (proliferative response to PDGF). Tendon cellularity declined significantly with age in both strains (p < 0.05), while both young and old patellar tendon fibroblasts in both strains had a significant (> 100%) increase in DNA synthesis with the addition of PDGF (p < 0.05). Although there was a trend to lower proliferative responses in older tendons, the differences were not significant. Autoradiographic analysis of labeling indices in F344 tendons showed a diminished responsiveness to PDGF (p < 0.04, ANOVA). Strain and side response on a per cell or tissue weight basis were not significant factors. Under appropriate experimental conditions, these two animal models of aging showed declines in responses to high levels of PDGF, suggesting that the PT reflects an age-dependent diminished capacity for wound repair.

Introduction:Although patellar tendon injuries are common but chronic patellar tendon rupture are rare injuries but severely disabling. Problems associated with this injury are scar formation, atrophy and contracture of the quadriceps, poor quality of remaining reabsorbed tendon, inadequate soft tissue, proximal patellar migration and prolonged post operative immobilization. Hence these injuries are technically difficult to repair with invariably poor functional outcome. We report such a case of neglected patellar tendon injury in a leprotic patient successfully treated with trans-osseous encirclage wire and turn-o-flap.Case Report:61 years old leprotic male presented after 10 months of trauma due to dog bite with decreased range of movement arc of left knee joint and inability to run. On examination, below the healed scar at knee, a palpable gap was present. X rays showed patella alta with loss of soft tissue continuity of patellar tendon and decreased insall salvati index. The neglected patellar tendon injury was repaired with end to end approximation and doubly augmenting it firstly with transosseous wire between patella and tibial tuberosity and further augmented by turn o flap of quadriceps over the repair, having excellent results after 2 years of follow up.Conclusion:Delayed and chronic repairs are challenging to treat and rehabilitate. Accurate early diagnosis of complete patellar tendon rupture allows for an easier and stronger repair, giving the best clinical results. End to end repair with double augmentation of repaired stump by transosseous S-S wire reinforcement and further, turn-O-flap of quadriceps in single stage, to increase the strength of repair, allow earlier mobilization and preventing secondary re rupture giving excellent results.

Transosseous tunnels versus suture anchors for the repair of acute quadriceps and patellar tendon ruptures: A systematic review and meta-analysis of biomechanical studies

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

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

A biomechanical comparison of patellar tendon repair materials in a bovine model (SS-54)

BackgroundTendinopathies of the patellar and Achilles tendons are common injuries among athletes and the general population. These injuries are costly, time-intensive to treat, and significantly limit activity. Predicting and eventually...