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Published on: April 30, 2014
Patellar Tendon Reconstruction After Failed Patellar Tendon Repair With a Concomitant Double-Bundle Posterior
Nicholas K Retzer1,2, Rylan A Behnke1,2, Benjiman J Wilebski1
1Twin Cities Orthopedics, Edina, Minnesota, USA.
Background:
Patellar tendon ruptures are a relatively uncommon injury that results from a contraction of the quadriceps against a fixed eccentric load during partial knee flexion. The medial collateral ligament (MCL) and posterior cruciate ligament (PCL) are frequently injured together, and their reconstitution should follow anatomic reconstruction techniques.
Indications:
In a previously failed patellar tendon repair, a reconstruction with an allograft is indicated due to poor tissue quality. The failed patellar tendon repair was further complicated by a chronic PCL tear and a chronic high-grade MCL sprain, confirmed through a physical examination and imaging. A double-bundle PCL reconstruction and MCL reconstruction were performed during the revision of the patellar tendon reconstruction to further stabilize the knee.
Technique Description:
The technique described was for a patellar tendon reconstruction with a concomitant double-bundle PCL reconstruction and MCL reconstruction after a failed patellar tendon repair in the presence of chronic PCL and MCL tears. First, hamstring autografts were harvested for anatomic MCL reconstruction and subsequently fixated distally. Next, tunnels were created through the tibial tubercle and the patella for patellar tendon reconstruction using a hamstring allograft. Then, femoral tunnels for both bundles of the PCL and the correlating tibial tunnel were prepared. After an arthroscopic assessment of the knee joint, the double-bundle PCL allografts were passed and fixed in their respective tunnels. Lastly, the proximal MCL autograft was fixed in a femoral tunnel, and the patellar tendon reconstruction grafts were passed and secured.
Results:
Recent literature has supported the use of a patellar tendon reconstruction in the setting of a failed repair and chronic patellar tendon rupture. Outcomes are favorable among metrics, including knee range of motion, extension lag, and modified Cincinnati and Kujala scores.
Discussion/Conclusion:
Recent literature has demonstrated improved functional outcomes with anatomic reconstructions of the patellar tendon, MCL, and PCL. A patellar tendon reconstruction after a failed repair with a concomitant double-bundle PCL reconstruction and MCL reconstruction is described, along with technical considerations, to improve chances of favorable outcomes and minimize the risks of complications.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
