Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MAO Yunhe , SUN Weihao , XIONG Yan , LI Qi , CHEN Gang , TANG Xin , FU Weili ,  LI Jian

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LI Jian, Email: hxlijian.china@163.com

Keywords：

Chronic patellar tendon rupture; patellar tendon reconstruction; autologous hamstring tendon; patella alta

DOI：

10.7507/1002-1892.202010032

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Objective To investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects.Methods The clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed. The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts, in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella, and 1 bone tunnel was created beneath the tibial tuberosity. There were 8 males and 3 females with an average age of 30.1 years (range, 10-61 years). The average interval from the primary injury to the operation was 9.5 months (range, 2-36 months). According to Yousef classification, there were 7 cases of type A2, 3 cases of type B2, and 1 case of type C2. The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm (range, 2.7-7.1 cm). Subjective function scores [including International Knee Documentation Committee (IKDC) subjective score, Tegner activity level, and Lysholm score] were evaluated before operation and at last follow-up. The loss of knee extension, Caton index, and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured.Results All patients were followed up 24-66 months (mean, 34.2 months). All incisions were primary healing, and there were no complications such as wound infection, venous thrombosis of the lower extremities, stiffness of the knee joint, graft failure, neurovascular injury, etc. No second revision surgery was performed during the follow-up. At last follow-up, the subjective function scores (IKDC subjective score, Tegner activity level, Lysholm score), loss of knee extension, thigh circumference difference, and Caton index were significantly improved when compared with those before operation (P<0.05). Two patients still had patella alta, with Caton indexes of 1.29 and 1.32, respectively.Conclusion In the treatment of chronic patellar tendon ruptures and defects, the modified patellar tendon reconstruction using hamstring autograft can significantly improve the postoperative knee function, restore the normal range of knee extension, enhance the extensor and correct the patella alta.

Citation： MAO Yunhe, SUN Weihao, XIONG Yan, LI Qi, CHEN Gang, TANG Xin, FU Weili, LI Jian. Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 160-165. doi: 10.7507/1002-1892.202010032 Copy

1.	Gilmore JH, Clayton-Smith ZJ, Aguilar M, et al. Reconstruction techniques and clinical results of patellar tendon ruptures: Evidence today. Knee, 2015, 22(3): 148-155.
2.	Mittal R, Singh DP, Kapoor A. Neglected patellar tendon rupture: preserve the fat pad. Orthopedics, 2011, 34(2): 134.
3.	Shepard GJ, Christodoulou L, Hegab AI. Neglected rupture of the patellar tendon. Arch Orthop Trauma Surg, 1999, 119(3-4): 241-242.
4.	Wiegand N, Naumov I, Vámhidy L, et al. Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia. Knee, 2013, 20(2): 139-143.
5.	Greis PE, Lahav A, Holmstrom MC. Surgical treatment options for patella tendon rupture, part Ⅱ: chronic. Orthopedics, 2005, 28(8): 765-769.
6.	Abdou YE. Reconstruction of a chronic patellar tendon rupture with semitendinosus autograft. Arch Orthop Trauma Surg, 2014, 134(12): 1717-1721.
7.	Casey MT, Tietjens BR. Neglected ruptures of the patellar tendon. A case series of four patients. Am J Sports Med, 2001, 29(4): 457-460.
8.	Tsitskaris K, Subramanian P, Crone D. Neglected patellar tendon rupture Reconstruction using semitendinosus-gracilis tendon grafts and FiberWire augmentation. JRSM Short Rep, 2013, 4(8): 2042533313490286.
9.	Isiklar ZU, Varner KE, Lindsey RW, et al. Late reconstruction of patellar ligament ruptures using Ilizarov external fixation. Clin Orthop Relat Res, 1996, (322): 174-178.
10.	Milankov MZ, Miljkovic N, Stankovic M. Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: a case report. Knee Surg Sports Traumatol Arthrosc, 2007, 15(12): 1445-1448.
11.	Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament: surgical technique and case report. Strategies Trauma Limb Reconstr, 2011, 6(1): 39-41.
12.	Takazawa Y, Ikeda H, Ishijima M, et al. Reconstruction of a ruptured patellar tendon using ipsilateral semitendinosus and gracilis tendons with preserved distal insertions: two case reports. BMC Res Notes, 2013, 6: 361.
13.	Temponi EF, Camelo N, Tuteja S, et al. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8): 2468-2473.
14.	Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. Knee, 2012, 19(4): 508-512.
15.	Ecker ML, Lotke PA, Glazer RM. Late reconstruction of the patellar tendon. J Bone Joint Surg (Am), 1979, 61(6A): 884-886.
16.	Dejour H, Denjean S, Neyret P. Treatment of old or recurrent ruptures of the patellar ligament by contralateral autograft. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(1): 58-62.
17.	Caton J, Deschamps G, Chambat P, et al. Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot, 1982, 68(5): 317-325.
18.	Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 19-26.
19.	Shabshin N, Schweitzer ME, Morrison WB, et al. MRI criteria for patella alta and baja. Skeletal Radiol, 2004, 33(8): 445-450.
20.	Yousef MA. Traumatic injury of the knee extensor mechanism in skeletally immature patients: Outcome and classification. Knee, 2019, 26(6): 1250-1261.
21.	Enad JG, Loomis LL. Primary patellar tendon repair and early mobilization: results in an active-duty population. J South Orthop Assoc, Spring, 2001, 10(1): 17-23.
22.	Lindy PB, Boynton MD, Fadale PD. Repair of patellar tendon disruptions without hardware. J Orthop Trauma, 1995, 9(3): 238-243.
23.	Ramseier LE, Werner CM, Heinzelmann M. Quadriceps and patellar tendon rupture. Injury, 2006, 37(6): 516-519.
24.	Collins KH, Herzog W, MacDonald GZ, et al. Obesity, metabolic syndrome, and musculoskeletal disease: common inflammatory pathways suggest a central role for loss of muscle integrity. Front Physiol, 2018, 9: 112.
25.	Grassi W, De Angelis R, Lamanna G, et al. The clinical features of rheumatoid arthritis. Eur J Radiol, 1998, 27(Suppl 1): S18-24.
26.	Sierra-Jimenez G, Sanchez-Ortiz A, Aceves-Avila FJ, et al. Tendinous and ligamentous derangements in systemic lupus erythematosus. J Rheumatol, 2008, 35(11): 2187-2191.
27.	Al-Ahaideb A, Lavoie G, Secretan C. Patellar tendon laxity in systemic lupus erythematosus. Can J Surg, 2004, 47(5): 385-386.
28.	Bourikas LA, Kritikos HD, Papakostantinou OG, et al. Chronic alcohol consumption as a predisposing factor for multiple tendon ruptures in unusual sites in a patient with rheumatoid arthritis. Clin Exp Rheumatol, 2007, 25(3): 461-463.
29.	Everhart JS, Cole D, Sojka JH, et al. Treatment options for patellar tendinopathy: A systematic review. Arthroscopy, 2017, 33(4): 861-872.
30.	van Ark M, Zwerver J, van den Akker-Scheek I. Injection treatments for patellar tendinopathy. Br J Sports Med, 2011, 45(13): 1068-1076.
31.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
32.	Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med, 2001, 29(5): 600-613.
33.	Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res, 1985, (198): 43-49.
34.	Rubinstein RA, Shelbourne KD, VanMeter CD, et al. Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med, 1994, 22(3): 324-327.

1. Gilmore JH, Clayton-Smith ZJ, Aguilar M, et al. Reconstruction techniques and clinical results of patellar tendon ruptures: Evidence today. Knee, 2015, 22(3): 148-155.
2. Mittal R, Singh DP, Kapoor A. Neglected patellar tendon rupture: preserve the fat pad. Orthopedics, 2011, 34(2): 134.
3. Shepard GJ, Christodoulou L, Hegab AI. Neglected rupture of the patellar tendon. Arch Orthop Trauma Surg, 1999, 119(3-4): 241-242.
4. Wiegand N, Naumov I, Vámhidy L, et al. Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia. Knee, 2013, 20(2): 139-143.
5. Greis PE, Lahav A, Holmstrom MC. Surgical treatment options for patella tendon rupture, part Ⅱ: chronic. Orthopedics, 2005, 28(8): 765-769.
6. Abdou YE. Reconstruction of a chronic patellar tendon rupture with semitendinosus autograft. Arch Orthop Trauma Surg, 2014, 134(12): 1717-1721.
7. Casey MT, Tietjens BR. Neglected ruptures of the patellar tendon. A case series of four patients. Am J Sports Med, 2001, 29(4): 457-460.
8. Tsitskaris K, Subramanian P, Crone D. Neglected patellar tendon rupture Reconstruction using semitendinosus-gracilis tendon grafts and FiberWire augmentation. JRSM Short Rep, 2013, 4(8): 2042533313490286.
9. Isiklar ZU, Varner KE, Lindsey RW, et al. Late reconstruction of patellar ligament ruptures using Ilizarov external fixation. Clin Orthop Relat Res, 1996, (322): 174-178.
10. Milankov MZ, Miljkovic N, Stankovic M. Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: a case report. Knee Surg Sports Traumatol Arthrosc, 2007, 15(12): 1445-1448.
11. Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament: surgical technique and case report. Strategies Trauma Limb Reconstr, 2011, 6(1): 39-41.
12. Takazawa Y, Ikeda H, Ishijima M, et al. Reconstruction of a ruptured patellar tendon using ipsilateral semitendinosus and gracilis tendons with preserved distal insertions: two case reports. BMC Res Notes, 2013, 6: 361.
13. Temponi EF, Camelo N, Tuteja S, et al. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8): 2468-2473.
14. Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. Knee, 2012, 19(4): 508-512.
15. Ecker ML, Lotke PA, Glazer RM. Late reconstruction of the patellar tendon. J Bone Joint Surg (Am), 1979, 61(6A): 884-886.
16. Dejour H, Denjean S, Neyret P. Treatment of old or recurrent ruptures of the patellar ligament by contralateral autograft. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(1): 58-62.
17. Caton J, Deschamps G, Chambat P, et al. Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot, 1982, 68(5): 317-325.
18. Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 19-26.
19. Shabshin N, Schweitzer ME, Morrison WB, et al. MRI criteria for patella alta and baja. Skeletal Radiol, 2004, 33(8): 445-450.
20. Yousef MA. Traumatic injury of the knee extensor mechanism in skeletally immature patients: Outcome and classification. Knee, 2019, 26(6): 1250-1261.
21. Enad JG, Loomis LL. Primary patellar tendon repair and early mobilization: results in an active-duty population. J South Orthop Assoc, Spring, 2001, 10(1): 17-23.
22. Lindy PB, Boynton MD, Fadale PD. Repair of patellar tendon disruptions without hardware. J Orthop Trauma, 1995, 9(3): 238-243.
23. Ramseier LE, Werner CM, Heinzelmann M. Quadriceps and patellar tendon rupture. Injury, 2006, 37(6): 516-519.
24. Collins KH, Herzog W, MacDonald GZ, et al. Obesity, metabolic syndrome, and musculoskeletal disease: common inflammatory pathways suggest a central role for loss of muscle integrity. Front Physiol, 2018, 9: 112.
25. Grassi W, De Angelis R, Lamanna G, et al. The clinical features of rheumatoid arthritis. Eur J Radiol, 1998, 27(Suppl 1): S18-24.
26. Sierra-Jimenez G, Sanchez-Ortiz A, Aceves-Avila FJ, et al. Tendinous and ligamentous derangements in systemic lupus erythematosus. J Rheumatol, 2008, 35(11): 2187-2191.
27. Al-Ahaideb A, Lavoie G, Secretan C. Patellar tendon laxity in systemic lupus erythematosus. Can J Surg, 2004, 47(5): 385-386.
28. Bourikas LA, Kritikos HD, Papakostantinou OG, et al. Chronic alcohol consumption as a predisposing factor for multiple tendon ruptures in unusual sites in a patient with rheumatoid arthritis. Clin Exp Rheumatol, 2007, 25(3): 461-463.
29. Everhart JS, Cole D, Sojka JH, et al. Treatment options for patellar tendinopathy: A systematic review. Arthroscopy, 2017, 33(4): 861-872.
30. van Ark M, Zwerver J, van den Akker-Scheek I. Injection treatments for patellar tendinopathy. Br J Sports Med, 2011, 45(13): 1068-1076.
31. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
32. Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med, 2001, 29(5): 600-613.
33. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res, 1985, (198): 43-49.
34. Rubinstein RA, Shelbourne KD, VanMeter CD, et al. Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med, 1994, 22(3): 324-327.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects

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