Treatment of neglected patellar tendon rupture using hamstring tendons autograft

Abstract

Aim of the study: To describe anatomical reconstruction of neglected patellar tendon rupture for restoring proper function of the knee. Case description: 14 year old male patient sustained injury to his left knee while playing sports. At first he was diagnosed with acute medial patellar retinaculum tear. Surgery was performed at another hospital to repair retinacular tear and cast immobilization was prescribed for 6 weeks. During rehabilitation process patient noticed high position of the patella and lack of active knee extension. 13 months after initial injury patient was admitted to our clinic with a complaint of inability to extend his left knee. During clinical exam the defect of patellar tendon could be palpated, knee extension deficit of 30⁰. On the x-rays multiple heterotopic ossicles were visible and on the MRI chronic distal rupture of patellar tendon was confirmed. At 16 months post injury patellar tendon reconstruction was performed. During the surgery ossicles were removed and patella was released of scar tissue. Gracilis and semitendinosus graft was harvested preserving their distal tibial attachment. Horizontal tunnel through tibial tuberosity was drilled using 7 mm cannulated drill and both tendons passed to lateral side. 7 mm diameter tunnel was drilled horizontally through patella and one of the tendons was passed form medial to lateral and another one the opposite direction forming a 'figure of 8'. Repair was confirmed isometric before fixing it. The ends of the tendons were fixed in to the tibia using 4.5x14 mm Corkscrew® (Arthrex, Naples, FL, USA) suture anchor. Native patellar tendon was additionally augmented with 2 mm FiberTape® (Arthrex, Naples, FL, USA) using Kessler suture technique and the ends of the suture passed vertically through patella and tied on proximal pole. Conclusions: Hinged knee brace was applied with the maximum flexion set at 30° and weight bearing was allowed as tolerated. CPM was recommended after suture removal. 90° of flexion was gradually achieved at 6th week post surgery and the brace was removed. At 6 month follow-up full ROM of the knee was achieved and extensor mechanism was fully restored with no extension lag. At 12 month follow-up patient was no complaints but still needs to improve quadriceps muscle strength.